Healthcare Provider Details

I. General information

NPI: 1891487203
Provider Name (Legal Business Name): GABRIELLE MARIE BECK DO (AS OF 5/28/23)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MELLON WAY
LATROBE PA
15650-1197
US

IV. Provider business mailing address

216 DOWLING RD
JOHNSTOWN PA
15904-2602
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-1000
  • Fax:
Mailing address:
  • Phone: 814-270-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT022365
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: