Healthcare Provider Details

I. General information

NPI: 1497738280
Provider Name (Legal Business Name): HOWARD M. ECKSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PORTLAND WAY SOUTH
GALION OH
44833-0270
US

IV. Provider business mailing address

270 PORTLAND WAY SOUTH
GALION OH
44833-0270
US

V. Phone/Fax

Practice location:
  • Phone: 419-468-7613
  • Fax: 419-462-1260
Mailing address:
  • Phone: 419-468-7613
  • Fax: 419-462-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD058025L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35073897
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: