Provider Demographics
NPI:1386264448
Name:BECTON, JEREMY BROOKS (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:BROOKS
Last Name:BECTON
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 1:936 RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-6015
Mailing Address - Country:US
Mailing Address - Phone:601-520-4804
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:MAIL STOP '800501'
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0816
Practice Address - Country:US
Practice Address - Phone:434-924-5321
Practice Address - Fax:434-982-3816
Is Sole Proprietor?:No
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program