Basic Information
| Provider Information | |||||||||
| NPI: | 1124190095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BESWICK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4745 OGLETOWN-STANTON RD | ||||||||
| Address2: | MAP 1, SUITE 134 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027385300 | ||||||||
| FaxNumber: | 3027314822 | ||||||||
| Practice Location | |||||||||
| Address1: | 4745 OGLETOWN STANTON RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027385300 | ||||||||
| FaxNumber: | 3027314822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 07/06/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C1-0006166 | DE | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 001073101 | 05 | DE | MEDICAID |