Individual
JACK MICHAEL BECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
233 E LANCASTER AVE STE 200, ARDMORE, PA 19003
(610) 642-1643
Mailing address
PO BOX 13579, READING, PA 19612-3579
(484) 628-1324
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MDO42717E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001252808
—
PA
01
—
673732
HIGHMARK PIN
PA
Enumeration date
05/04/2006
Last updated
05/21/2024
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