Provider Demographics
NPI:1194712174
Name:BECKER, FREDERIC SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:SCOTT
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 1:860 1ST AVE STE 4B
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4033
Mailing Address - Country:US
Mailing Address - Phone:610-265-1251
Mailing Address - Fax:610-265-1252
Practice Address - Street 1:860 1ST AVE STE 4B
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:610-265-1251
Practice Address - Fax:610-265-1252
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055067L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015208830002Medicaid
PA633312Medicare PIN
PA0015208830002Medicaid