Provider Demographics
NPI:1639192578
Name:BECKER, CAROL PRATT (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:PRATT
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 VERSAILLES BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4113
Mailing Address - Country:US
Mailing Address - Phone:504-866-4115
Mailing Address - Fax:
Practice Address - Street 1:539 E PRUDHOMME ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6499
Practice Address - Country:US
Practice Address - Phone:337-942-6883
Practice Address - Fax:337-942-6883
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0190092085R0202X
TXJ74272085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1961205Medicaid
5R450Medicare ID - Type Unspecified
F46982Medicare UPIN