Healthcare Provider Details

I. General information

NPI: 1902900418
Provider Name (Legal Business Name): JEFFREY ALAN BECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVE, NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

712 BROMLEY ST
SILVER SPRING MD
20902-3051
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-0505
  • Fax: 202-782-5452
Mailing address:
  • Phone: 301-592-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD18789
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: