Healthcare Provider Details

I. General information

NPI: 1477838324
Provider Name (Legal Business Name): ALICIA D BECK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 BOSTON POST RD STE 10
OLD SAYBROOK CT
06475-1554
US

IV. Provider business mailing address

455 BOSTON POST RD STE 10
OLD SAYBROOK CT
06475-1554
US

V. Phone/Fax

Practice location:
  • Phone: 860-388-9799
  • Fax: 860-388-6626
Mailing address:
  • Phone: 860-388-9799
  • Fax: 860-388-6626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00662
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002637
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: