Provider Demographics
NPI:1851379549
Name:BECKER, ANDREW NACHOLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NACHOLAS
Last Name:BECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 SUMMERSON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2516
Mailing Address - Country:US
Mailing Address - Phone:410-484-4785
Mailing Address - Fax:
Practice Address - Street 1:15 WALKER AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4004
Practice Address - Country:US
Practice Address - Phone:410-486-6800
Practice Address - Fax:410-484-6534
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH31615207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD231120800Medicaid
C49063Medicare UPIN
KK08Medicare ID - Type Unspecified