MEDICARE: DR. RICHARD RUSSELL ECKERT M.D.

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	174400000X	Specialist	0101-047832	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	222413	OTHER	VA	SOUTHERN HEALTH
2	217216	OTHER	VA	ANTHEM
3	542009280-01	OTHER	VA	JOHN DEERE
4	0004252599	OTHER	VA	AETNA PIN #

General Provider Information

NPI Number	:	1982652988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD RUSSELL ECKERT M.D.

Provider Business Mailing Address
First Line	:	4370 STARKEY RD
Second Line	:	SUITE 4-C
City	:	ROANOKE
State	:	VA
Zip	:	24018-0603
Country	:	US
Telephone Number	:	540-989-4100
Fax Number	:	540-989-3667

Provider Business Practice Location Address
First Line	:	4370 STARKEY RD
Second Line	:	SUITE 4-C
City	:	ROANOKE
State	:	VA
Zip	:	24018-0603
Country	:	US
Telephone Number	:	540-989-4100
Fax Number	:	540-989-3667

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/27/2008

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