Provider Demographics
NPI:1750372256
Name:BECKERMAN, TOBIE ELY (MD)
Entity type:Individual
Prefix:
First Name:TOBIE
Middle Name:ELY
Last Name:BECKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 ROCKVILLE PIKE STE 660
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3106
Mailing Address - Country:US
Mailing Address - Phone:301-230-1488
Mailing Address - Fax:301-230-3199
Practice Address - Street 1:11140 ROCKVILLE PIKE STE 660
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3106
Practice Address - Country:US
Practice Address - Phone:301-230-1488
Practice Address - Fax:301-230-3199
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD433200800Medicaid
MD000F46021Medicare ID - Type Unspecified