Healthcare Provider Details

I. General information

NPI: 1962403634
Provider Name (Legal Business Name): HEATHER BECKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST SUITE 204
ARLINGTON MA
02476-4784
US

IV. Provider business mailing address

75 FRANCIS ST
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 781-648-9700
  • Fax:
Mailing address:
  • Phone: 617-732-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1840
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: