Provider Demographics
NPI:1285600338
Name:BECKER, IAN B (DO)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:B
Last Name:BECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-0460
Mailing Address - Country:US
Mailing Address - Phone:610-273-2429
Mailing Address - Fax:610-273-3798
Practice Address - Street 1:471 PEQUEA AVE
Practice Address - Street 2:
Practice Address - City:HONEY BROOK
Practice Address - State:PA
Practice Address - Zip Code:19344-0460
Practice Address - Country:US
Practice Address - Phone:610-273-2429
Practice Address - Fax:610-273-3798
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05009507L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017846300004Medicaid
PA0017846300004Medicaid