Healthcare Provider Details

I. General information

NPI: 1053312462
Provider Name (Legal Business Name): MARK BECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S GRANT AVE
COLUMBUS OH
43215-4701
US

IV. Provider business mailing address

PO BOX 951822
CLEVELAND OH
44193-0020
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9506
  • Fax: 614-566-8224
Mailing address:
  • Phone: 216-464-5160
  • Fax: 216-464-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35067132
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: