Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 55003 | MA |
NPI | 1174513899 |
---|---|
Provider Name | Stephan M Becker |
First Address | Waltham, MA 02451-1991 |
Second Address | Taunton, MA 02780-2465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3015394 | (05) | MA |
436274 | HPHC (01) | MA |
754131 | TUFTS (01) | MA |
B77071 | (02) | |
J06011 | BCBS (01) | MA |