=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912186644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BECKER & ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 01/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 WALKER AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-4023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-486-6800
-----------------------------------------------------
Fax | 410-484-6534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 WALKER AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-4023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-486-6800
-----------------------------------------------------
Fax | 410-484-6534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANDREW BECKER
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 410-486-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | H31615
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------