Provider Demographics
NPI:1053502559
Name:DENIS I BECKER MD PA
Entity Type:Organization
Organization Name:DENIS I BECKER MD PA
Other - Org Name:RALEIGH ENDOCRINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-876-7692
Mailing Address - Street 1:PO BOX 24848
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4848
Mailing Address - Country:US
Mailing Address - Phone:336-714-2505
Mailing Address - Fax:336-714-2550
Practice Address - Street 1:3410 EXECUTIVE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-876-7692
Practice Address - Fax:919-954-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17330207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0199AOtherBCBS
NC890199AMedicaid
NCDN4844OtherRR MEDICARE
NC890199AMedicaid