Provider Demographics
NPI:1003097395
Name:RICHARD R. RECKO D.P.M., PA
Entity Type:Organization
Organization Name:RICHARD R. RECKO D.P.M., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:RECKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-762-2404
Mailing Address - Street 1:1776 WELLINGTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6075
Mailing Address - Country:US
Mailing Address - Phone:910-762-2404
Mailing Address - Fax:910-762-4249
Practice Address - Street 1:1776 WELLINGTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6075
Practice Address - Country:US
Practice Address - Phone:910-762-2404
Practice Address - Fax:910-762-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC213213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908139Medicaid
NCDD0367OtherRAILROAD MEDICARE
NC08139OtherBCBS
NCDD0367OtherRAILROAD MEDICARE
T64078Medicare UPIN
NC243120AMedicare PIN