Provider Demographics
NPI:1295861805
Name:GECKLE, STEPHEN L (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:GECKLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE 512
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-583-0300
Mailing Address - Fax:410-583-0306
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 512
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-583-0300
Practice Address - Fax:410-583-0306
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001046363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP98794Medicare UPIN
675LH20Medicare ID - Type Unspecified