Basic Information
| Provider Information | |||||||||
| NPI: | 1184662488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 WESTVIEW RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030334421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034000160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 545 BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023243117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086973677 | ||||||||
| FaxNumber: | 5086979396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 210720 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 9510 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3086747 | 05 | NH | MEDICAID | 110077744A | 05 | MA | MEDICAID |