MEDICARE: GORDON RICHARD ECK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS-004444-L	PA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	OS-004444-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437156387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON RICHARD ECK D.O.

Provider Business Mailing Address
First Line	:	50 COMMERCE DR
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3335
Country	:	US
Telephone Number	:	610-372-8044
Fax Number	:	484-334-7026

Provider Business Practice Location Address
First Line	:	11 S PINE ST
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9720
Country	:	US
Telephone Number	:	610-286-9000
Fax Number	:	610-286-9410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/01/2012

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