Provider Demographics
NPI:1346272796
Name:MICHAEL, BECKIE (DO)
Entity Type:Individual
Prefix:DR
First Name:BECKIE
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 ROUTE 70 E STE F120A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2357
Mailing Address - Country:US
Mailing Address - Phone:856-988-8800
Mailing Address - Fax:856-988-8804
Practice Address - Street 1:775 ROUTE 70 E STE F120A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2357
Practice Address - Country:US
Practice Address - Phone:856-988-8800
Practice Address - Fax:856-988-8804
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007703L207R00000X, 207RN0300X
NJ25MB05513800207R00000X, 207RN0300X
OK5253207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7429207Medicaid
NJ026265VJGMedicare PIN
MOMA5387001Medicare PIN
OK296819YTFMMedicare PIN
F53460Medicare UPIN
NJP00396684Medicare PIN