Healthcare Provider Details

I. General information

NPI: 1194791863
Provider Name (Legal Business Name): ANN NICOLOFF BECKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 WASHINGTON ST SUITE 275
WELLESLEY MA
02481-6219
US

IV. Provider business mailing address

1227 HIGH ST
WESTWOOD MA
02090-2764
US

V. Phone/Fax

Practice location:
  • Phone: 781-235-7730
  • Fax:
Mailing address:
  • Phone: 781-255-5963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number73532
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: