Provider Demographics
NPI:1679586796
Name:BECKER, VICTOR PAUL (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:PAUL
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22 WALNUT ST
Mailing Address - Street 2:LAUREL HEALTH CENTER ADMINISTRATION
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1526
Mailing Address - Country:US
Mailing Address - Phone:570-723-0500
Mailing Address - Fax:570-724-1197
Practice Address - Street 1:7 WATER ST
Practice Address - Street 2:WELLSBORO LAUREL HEALTH CENTER
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1126
Practice Address - Country:US
Practice Address - Phone:570-724-1010
Practice Address - Fax:570-724-3970
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-09-01
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Provider Licenses
StateLicense IDTaxonomies
PAMD068248L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001792391Medicaid
G94581Medicare UPIN