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NPI Code Detail

MEDICARE: MARY ELLEN BECKER M.D

MEDICARE: MARY ELLEN BECKER M.D
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
12084P0800XPsychiatry Physician43170CO
22084P0800XPsychiatry PhysicianA79433CA

General Provider Information

NPI Number : 1194827378
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELLEN BECKER M.D
Provider Business Mailing Address
First Line : 1723 STONEHENGE DR
Second Line :
City : LAFAYETTE
State : CO
Zip : 80026-9113
Country : US
Telephone Number : 303-955-0876
Fax Number :
Provider Business Practice Location Address
First Line : 1333 IRIS AVE
Second Line :
City : BOULDER
State : CO
Zip : 80304-2226
Country : US
Telephone Number : 303-443-8500
Fax Number : 303-449-6029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2006
Last Update Date : 07/08/2007

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