Healthcare Provider Details

I. General information

NPI: 1043888787
Provider Name (Legal Business Name): RAVEN BECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-1000
  • Fax:
Mailing address:
  • Phone: 984-974-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-12228
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number2025-00360
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: