Provider Demographics
NPI:1669819827
Name:TANYA J. BECKER MD, INC.
Entity Type:Organization
Organization Name:TANYA J. BECKER MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-728-9206
Mailing Address - Street 1:59 PROSPECT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4482
Mailing Address - Country:US
Mailing Address - Phone:401-728-9206
Mailing Address - Fax:401-722-6960
Practice Address - Street 1:59 PROSPECT ST
Practice Address - Street 2:SUITE C
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4482
Practice Address - Country:US
Practice Address - Phone:401-728-9206
Practice Address - Fax:401-722-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10708208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI543748627OtherUHC
RITB55273Medicaid
RI275263078AOtherNHP
RI963015OtherCIGNA
RIAA26320OtherHP
RI2011993783OtherTRICARE
RI29029-4OtherBCBS
RI2033621OtherFIRST HEALTH