Provider Demographics
NPI:1568461531
Name:BECK, THOMAS D JR (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:BECK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FRANKLIN AVE
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1215
Mailing Address - Country:US
Mailing Address - Phone:410-641-1900
Mailing Address - Fax:410-641-9473
Practice Address - Street 1:314 FRANKLIN AVE
Practice Address - Street 2:SUITE 105B
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1215
Practice Address - Country:US
Practice Address - Phone:410-641-1900
Practice Address - Fax:410-641-9473
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0058396207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD257M342FMedicare ID - Type Unspecified
DEG01505A01Medicare PIN
G68432Medicare UPIN