Provider Demographics
NPI:1710916325
Name:BECK, GERALD ELDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ELDEN
Last Name:BECK
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 1:1028 LOOKOUT DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1061
Mailing Address - Country:US
Mailing Address - Phone:814-456-8210
Mailing Address - Fax:
Practice Address - Street 1:510 CRANBERRY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1075
Practice Address - Country:US
Practice Address - Phone:814-459-3141
Practice Address - Fax:814-459-4641
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD007040E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005905060008Medicaid
PAC27009Medicare UPIN