Provider Demographics
NPI:1992783666
Name:BECKER, STEPHANIE R (NP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:BECKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 SUMMERSON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2516
Mailing Address - Country:US
Mailing Address - Phone:410-484-4785
Mailing Address - Fax:
Practice Address - Street 1:15 WALKER AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4004
Practice Address - Country:US
Practice Address - Phone:410-486-6800
Practice Address - Fax:410-484-6534
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR088031363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD791330300Medicaid
KK0826PPMedicare ID - Type Unspecified