Basic Information
| Provider Information | |||||||||
| NPI: | 1700834199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 HUNTINGDON PIKE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | MEADOWBROOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190468004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159471447 | ||||||||
| FaxNumber: | 2159472603 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 HUNTINGDON PIKE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | MEADOWBROOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190468004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159471447 | ||||||||
| FaxNumber: | 2159472603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD067153L | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.