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General NPI Number Information
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NPI Number | 1295861805
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Entity Type | Individual
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Provider Name | STEPHEN L GECKLE PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6565 N CHARLES ST SUITE 512
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City | TOWSON
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State | MD
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Zip | 21204-6800
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Country | US
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Telephone | 410-583-0300
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Fax | 410-583-0306
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Provider Business Mailing Address
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Address Line | 6565 N CHARLES ST SUITE 512
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City | TOWSON
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State | MD
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Zip | 21204-6800
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Country | US
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Telephone | 410-583-0300
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Fax | 410-583-0306
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0001046
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License Number State | MD
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