Provider Demographics
NPI:1093779878
Name:ECKERT, JULIA M (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:ECKERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2413
Mailing Address - Country:US
Mailing Address - Phone:567-890-7138
Mailing Address - Fax:419-586-0812
Practice Address - Street 1:909 E WAYNE ST
Practice Address - Street 2:SUITE 124
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3304
Practice Address - Country:US
Practice Address - Phone:419-586-1863
Practice Address - Fax:419-586-3045
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-1957399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200235780AMedicaid
IN000000083941OtherBLUE CROSS BLUE SHIELD
OH2643278Medicaid
G98567Medicare UPIN
IN453220BBBMedicare PIN
OH2643278Medicaid
IN262490KKMedicare PIN