Healthcare Provider Details

I. General information

NPI: 1003097395
Provider Name (Legal Business Name): RICHARD R. RECKO D.P.M., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 WELLINGTON AVE SUITE 1
WILMINGTON NC
28403-6075
US

IV. Provider business mailing address

1776 WELLINGTON AVE SUITE 1
WILMINGTON NC
28403-6075
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-2404
  • Fax: 910-762-4249
Mailing address:
  • Phone: 910-762-2404
  • Fax: 910-762-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number213
License Number StateNC

VIII. Authorized Official

Name: RICHARD R. RECKO
Title or Position: CEO
Credential: DPM
Phone: 910-762-2404