Provider Demographics
NPI:1083774327
Name:ECKMAN, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:ECKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10597 MONTGOMERY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4472
Mailing Address - Country:US
Mailing Address - Phone:513-793-6861
Mailing Address - Fax:513-985-2743
Practice Address - Street 1:10597 MONTGOMERY RD STE 200
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4472
Practice Address - Country:US
Practice Address - Phone:513-793-6861
Practice Address - Fax:513-985-2743
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 093231207R00000X
MDD62806207R00000X, 207RA0201X
OH35. 093231207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409289900Medicaid
OHEC4268931OtherMEDICARE PTAN
MDI35139Medicare UPIN
MDKR65L756Medicare ID - Type Unspecified
H010132Medicare PIN