Provider Demographics
NPI:1881637353
Name:BECK, GRETCHEN S (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:S
Last Name:BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 GLENWOOD STATION LANE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1697
Mailing Address - Country:US
Mailing Address - Phone:434-977-6673
Mailing Address - Fax:434-220-3197
Practice Address - Street 1:941 GLENWOOD STATION LANE
Practice Address - Street 2:SUITE #103
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1697
Practice Address - Country:US
Practice Address - Phone:434-977-6673
Practice Address - Fax:434-220-3197
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225810207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA147589OtherSOUTHERN HEALTH ID
VA323663OtherANTHEM/TRIGON/BCBS ID
VA030000102Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
VAH46364Medicare UPIN