Active NPI
Gary Lee Becker, MD
- Dermatology Physician
- Ridley Park, PA
National Provider Identifier
1497776298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MD013511E
- Practice address
- 204 E Chester Pike
Ridley Park, PA 19078-1730 - Phone
- (610) 521-1141
- Fax
- (610) 521-2651
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MD013511E | PA | Primary |
Addresses
Primary practice location
204 E Chester Pike
Ridley Park, PA 19078-1730
Mailing address
204 E Chester Pike
Ridley Park, PA 19078-1730
Phone (610) 521-1141
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0031681000 | Other | PA | KEYSTONE HMO |
| 0031681000 | Other | PA | BLUE SHIELD PPO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497776298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 E CHESTER PIKE",
"city": "RIDLEY PARK",
"state": "PA",
"postal_code": "190781730",
"telephone_number": "610-521-1141",
"fax_number": "610-521-2651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 E CHESTER PIKE",
"city": "RIDLEY PARK",
"state": "PA",
"postal_code": "190781730",
"telephone_number": "610-521-1141",
"fax_number": "610-521-2651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BECKER",
"first_name": "GARY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "PA",
"license": "MD013511E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE HMO",
"identifier": "0031681000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PPO",
"identifier": "0031681000",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ridley Park, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.