Provider Demographics
NPI:1710020821
Name:ALBERT E. BECKER, M.D. INC
Entity Type:Organization
Organization Name:ALBERT E. BECKER, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-399-2142
Mailing Address - Street 1:30 W MCCREIGHT AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1842
Mailing Address - Country:US
Mailing Address - Phone:937-399-2142
Mailing Address - Fax:937-399-1945
Practice Address - Street 1:30 W MCCREIGHT AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1842
Practice Address - Country:US
Practice Address - Phone:937-399-2142
Practice Address - Fax:937-399-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34785207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC01668Medicare UPIN