Provider Demographics
NPI:1679556765
Name:BECKER, PHILIP S (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 MONTGOMERY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2198
Mailing Address - Country:US
Mailing Address - Phone:513-961-5558
Mailing Address - Fax:513-961-1912
Practice Address - Street 1:320 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3410
Practice Address - Country:US
Practice Address - Phone:859-341-4266
Practice Address - Fax:859-341-4144
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0600272084N0400X
KY271382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000526921OtherANTHEM
KY64271380Medicaid
OH646978OtherAETNA
IN200070230AMedicaid
OH0791737Medicaid
OH2377438-002OtherCIGNA
OH05-20161OtherUNITED HEALTHCARE
KY00384OtherMEDICARE GROUP NUMBER
OH0791737Medicaid
KY000000526921OtherANTHEM
OH646978OtherAETNA
KY00384001Medicare PIN