Provider Demographics
NPI:1922064765
Name:BECKER, MARTIN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:DOUGLAS
Last Name:BECKER
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 1:1141 OPAL COURT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:301-791-6666
Mailing Address - Fax:301-791-4549
Practice Address - Street 1:1141 OPAL COURT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-791-6666
Practice Address - Fax:301-791-4549
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00298222080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD78016Medicare UPIN