Healthcare Provider Details

I. General information

NPI: 1851328314
Provider Name (Legal Business Name): SCOTT BERNARD BECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 COLUMBIA 100 PARKWAY SUITE 101
COLUMBIA MD
21045
US

IV. Provider business mailing address

8860 COLUMBIA 100 PARKWAY SUITE 101
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-9900
  • Fax: 410-997-4498
Mailing address:
  • Phone: 410-997-9900
  • Fax: 410-997-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0056190
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: