Basic Information
| Provider Information | |||||||||
| NPI: | 1740414820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5501 OLD YORK ROAD, KORMAN BASEMENT | ||||||||
| Address2: | TABOR EMERGENCY PHYSICIANS | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154566679 | ||||||||
| FaxNumber: | 2154568502 | ||||||||
| Practice Location | |||||||||
| Address1: | 5501 OLD YORK ROAD, KORMAN BASEMENT | ||||||||
| Address2: | TABOR EMERGENCY PHYSICIANS | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154566679 | ||||||||
| FaxNumber: | 2154568502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | MD4367000 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.