Provider Demographics
NPI:1427149541
Name:BECK, KATHLEEN (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:PA
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 1974
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0974
Mailing Address - Country:US
Mailing Address - Phone:866-668-0313
Mailing Address - Fax:
Practice Address - Street 1:600 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3765
Practice Address - Country:US
Practice Address - Phone:301-723-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC02597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00296861OtherRAILROAD MEDICARE
MDP00296861OtherRAILROAD MEDICARE
MDP00704225Medicare PIN
MDF824Medicare PIN
MDP88168Medicare UPIN