Provider Demographics
NPI:1447309539
Name:BECK, BRUCE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEE
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 HOSPITAL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4019
Mailing Address - Country:US
Mailing Address - Phone:866-705-5729
Mailing Address - Fax:410-535-6954
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4019
Practice Address - Country:US
Practice Address - Phone:866-705-5729
Practice Address - Fax:410-535-6954
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17264207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200010750OtherMEDICARE RAIL ROAD PRDR #
MDP819Medicare ID - Type Unspecified
MD200010750OtherMEDICARE RAIL ROAD PRDR #