Provider Demographics
NPI:1417952276
Name:EUCKER, JONATHAN T (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
Last Name:EUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:T
Other - Last Name:EUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:800 E WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3359
Mailing Address - Country:US
Mailing Address - Phone:330-726-4833
Mailing Address - Fax:330-726-1123
Practice Address - Street 1:800 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3359
Practice Address - Country:US
Practice Address - Phone:330-726-4833
Practice Address - Fax:330-726-1123
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35073212E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2195146Medicaid
OH4035641Medicare PIN
OHH26905Medicare UPIN