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General NPI Number Information
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NPI Number | 1114954617
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Entity Type | Organization
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Legal Business Name | MELISSA BECKER, LLC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 661 PARK AVE E
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City | MANSFIELD
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State | OH
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Zip | 44905-2880
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Country | US
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Telephone | 419-522-0948
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Fax | 419-526-7347
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Provider Business Mailing Address
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Address Line | 661 PARK AVE E
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City | MANSFIELD
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State | OH
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Zip | 44905-2880
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Country | US
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Telephone | 419-522-0948
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Fax | 419-526-7347
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. MELISSA BECKER
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Credential | M.D.
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Telephone | 419-522-0948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35079962B
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License Number State | OH
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