Healthcare Provider Details

I. General information

NPI: 1932447679
Provider Name (Legal Business Name): TRICIA R ECKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18947 JOHN J WILLIAMS HWY UNIT 212
REHOBOTH BEACH DE
19971-4476
US

IV. Provider business mailing address

48 CRESTVIEW DR OPTIONAL
MIFFLIN PA
17058-9753
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-8212
  • Fax: 302-645-2199
Mailing address:
  • Phone: 717-994-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055902
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: