Healthcare Provider Details

I. General information

NPI: 1003967910
Provider Name (Legal Business Name): DAVID LOWELL BECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/07/2023
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MATTHEWS TOWNSHIP PKWY SUITE 450
MATTHEWS NC
28105-2387
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-8480
  • Fax: 704-384-8481
Mailing address:
  • Phone: 919-497-3526
  • Fax: 919-497-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberJ7305
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008-01706
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: