Provider Demographics
NPI:1629019948
Name:BECK, MARY ELIZABETH (PA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:BECK-GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1447 YORK RD STE 406
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6057
Mailing Address - Country:US
Mailing Address - Phone:410-343-3001
Mailing Address - Fax:410-823-0015
Practice Address - Street 1:1447 YORK RD STE 406
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-343-3001
Practice Address - Fax:410-823-0015
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051984363A00000X, 363AM0700X, 363AS0400X
MDC0002845363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ24271Medicare UPIN
MD731LP750Medicare PIN