Provider Demographics
NPI:1437156387
Name:ECK, GORDON RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:RICHARD
Last Name:ECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3335
Mailing Address - Country:US
Mailing Address - Phone:610-372-8044
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:11 S PINE ST
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9720
Practice Address - Country:US
Practice Address - Phone:610-286-9000
Practice Address - Fax:610-286-9410
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-004444-L207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000693942Medicaid
PAD98750Medicare UPIN
PA000693942Medicaid