Provider Demographics
NPI:1265471262
Name:MECKLER, GARY MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MITCHELL
Last Name:MECKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:M
Other - Last Name:MECKLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:174 GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1743
Mailing Address - Country:US
Mailing Address - Phone:740-369-1948
Mailing Address - Fax:
Practice Address - Street 1:174 GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1743
Practice Address - Country:US
Practice Address - Phone:740-369-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.045688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0449143Medicaid
OHME0489103Medicare ID - Type Unspecified
OH0449143Medicaid
OH0449143Medicaid
A79868Medicare UPIN