Provider Demographics
NPI:1164515151
Name:BECKER, DAVID I (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:I
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1493 CAMBRIDGE ST
Mailing Address - Street 2:CHA - SURGERY - CAMBRIDGE CAMPUS
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1047
Mailing Address - Country:US
Mailing Address - Phone:617-665-2555
Mailing Address - Fax:617-665-3598
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:CHA - SURGERY - CAMBRIDGE CAMPUS
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-2555
Practice Address - Fax:617-665-3598
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA207526208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0124338Medicaid
MA0124338Medicaid
A31471Medicare ID - Type Unspecified