Provider Demographics
NPI:1306814736
Name:ECKERT, STEPHANIE (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ECKERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 POND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2258
Mailing Address - Country:US
Mailing Address - Phone:610-366-7444
Mailing Address - Fax:610-366-0884
Practice Address - Street 1:6553 HOFFMAN LN
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-3030
Practice Address - Country:US
Practice Address - Phone:610-366-7444
Practice Address - Fax:610-366-0884
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009276L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA500134OtherGROUP AETNA #
PA7077147OtherAETNA
PA01048101OtherCAP BLUE CROSS
PA02294500OtherGROUP CAP BLUE CROSS NUMB
PA0268906000OtherKHPE
PA122834OtherMEDPLUS
PA993220OtherKHPC
PA124389OtherGROUP PA BLUE SHIELD #
PA1511442OtherGROUP GATEWAY
PA0018039500001Medicaid
PA0794403000OtherKHPE
PA0917174OtherPA BLUE SHIELD
PA1518827OtherGATEWAY
PA026890600OtherGROUP KHPE
PA20008892OtherAMERIHEALTH MERCY
PA0268906000OtherKHPE
PA0917174OtherPA BLUE SHIELD
PA1511442OtherGROUP GATEWAY