MEDICARE: MELISSA BECKER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35079962B	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114954617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA BECKER, LLC

Provider Business Mailing Address
First Line	:	661 PARK AVE E
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44905-2880
Country	:	US
Telephone Number	:	419-522-0948
Fax Number	:	419-526-7347

Provider Business Practice Location Address
First Line	:	661 PARK AVE E
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44905-2880
Country	:	US
Telephone Number	:	419-522-0948
Fax Number	:	419-526-7347

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. MELISSA BECKER
Credential	:	M.D.
Telephone Number	:	419-522-0948

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/22/2020

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Directions to “MELISSA BECKER, LLC ” Practice Location

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