Provider Demographics
NPI:1487884557
Name:BECKMAN, MARCIA HENDRICKS (RD, CDE)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:HENDRICKS
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 EDGEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3004
Mailing Address - Country:US
Mailing Address - Phone:585-752-5855
Mailing Address - Fax:
Practice Address - Street 1:122 EDGEVIEW LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3004
Practice Address - Country:US
Practice Address - Phone:585-752-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY712452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered