Provider Demographics
NPI:1194791863
Name:BECKER, ANN NICOLOFF (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:NICOLOFF
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 1:1227 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2764
Mailing Address - Country:US
Mailing Address - Phone:781-255-5963
Mailing Address - Fax:
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:SUITE 275
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6219
Practice Address - Country:US
Practice Address - Phone:781-235-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA735322080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3147185Medicaid
MA3147185Medicaid