Provider Demographics
NPI:1699881219
Name:BECK, HEATHER LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:BECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10401 HOSPITAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3150
Mailing Address - Country:US
Mailing Address - Phone:301-856-2323
Mailing Address - Fax:855-385-5335
Practice Address - Street 1:10401 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3150
Practice Address - Country:US
Practice Address - Phone:301-856-2323
Practice Address - Fax:855-385-5335
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBE000052128Medicaid
ALS87533Medicare UPIN
ALBE000052128Medicaid