Provider Demographics
NPI:1205817491
Name:BECKER, ANNE EDITH (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:EDITH
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-2934
Mailing Address - Fax:617-726-7541
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 816
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-2934
Practice Address - Fax:617-726-7541
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA769712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3107566Medicaid
MA730450OtherTUFTS HEALTH PLAN
MAJ13757Medicare ID - Type Unspecified
MA3107566Medicaid