Provider Demographics
NPI:1104520345
Name:BECKER, MARIEL VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:VICTORIA
Last Name:BECKER
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 1:800 ROSE STREET
Mailing Address - Street 2:ROOM C-368
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-218-1661
Mailing Address - Fax:859-257-7167
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:ROOM C-368
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-218-1661
Practice Address - Fax:859-257-7167
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program