Provider Demographics
NPI:1114954617
Name:MELISSA BECKER, LLC
Entity Type:Organization
Organization Name:MELISSA BECKER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-522-0948
Mailing Address - Street 1:661 PARK AVE E
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-2880
Mailing Address - Country:US
Mailing Address - Phone:419-522-0948
Mailing Address - Fax:419-526-7347
Practice Address - Street 1:661 PARK AVE E
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-2880
Practice Address - Country:US
Practice Address - Phone:419-522-0948
Practice Address - Fax:419-526-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079962B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2283461Medicaid
OHBE4074532Medicare ID - Type Unspecified