Provider Demographics
NPI:1184043762
Name:BECKER, JEREMY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E UNIVERSITY PKWY
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2828
Mailing Address - Country:US
Mailing Address - Phone:410-554-2284
Mailing Address - Fax:410-554-2184
Practice Address - Street 1:210 E UNIVERSITY PKWY
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-554-2284
Practice Address - Fax:410-554-2184
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059803207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty