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General NPI Number Information
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NPI Number | 1255691820
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Entity Type | Individual
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Provider Name | THEODORE GARY ECKMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1910 SASSAFRAS ST STE 300
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City | ERIE
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State | PA
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Zip | 16502-2716
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Country | US
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Telephone | 814-452-7246
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Fax | 814-452-7244
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Provider Business Mailing Address
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Address Line | PO BOX 92987
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City | CLEVELAND
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State | OH
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Zip | 44194-2987
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Country | US
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Telephone | 440-997-2262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 35.128412
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License Number State | OH
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