Provider Demographics
NPI:1356332548
Name:BECK, LUCILLE S (MD)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:S
Last Name:BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-560-3510
Mailing Address - Fax:703-876-0253
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-560-3510
Practice Address - Fax:703-876-0253
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101034695207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5878829Medicaid
VA5878829Medicaid
DCC62468Medicare UPIN