Healthcare Provider Details

I. General information

NPI: 1851379549
Provider Name (Legal Business Name): ANDREW NACHOLAS BECKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WALKER AVE
BALTIMORE MD
21208-4004
US

IV. Provider business mailing address

2520 SUMMERSON RD
BALTIMORE MD
21209-2516
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-6800
  • Fax: 410-484-6534
Mailing address:
  • Phone: 410-484-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberH31615
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: