Provider Demographics
NPI:1497738280
Name:ECKSTEIN, HOWARD M (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:M
Last Name:ECKSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 PORTLAND WAY SOUTH
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-0270
Mailing Address - Country:US
Mailing Address - Phone:419-468-7613
Mailing Address - Fax:419-462-1260
Practice Address - Street 1:270 PORTLAND WAY SOUTH
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-0270
Practice Address - Country:US
Practice Address - Phone:419-468-7613
Practice Address - Fax:419-462-1260
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058025L208000000X
OH35073897208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001590618Medicaid
OH0269776Medicaid
G29172Medicare PIN
PA874325RNOMedicare ID - Type Unspecified
OH0269776Medicaid