Provider Demographics
NPI:1578507521
Name:ECKELS, DENNIS LEE (DO, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
Last Name:ECKELS
Suffix:
Gender:M
Credentials:DO, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:PA
Mailing Address - Zip Code:15954-0486
Mailing Address - Country:US
Mailing Address - Phone:814-446-5695
Mailing Address - Fax:814-446-4209
Practice Address - Street 1:238 INDIANA ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:PA
Practice Address - Zip Code:15954-2055
Practice Address - Country:US
Practice Address - Phone:814-446-5695
Practice Address - Fax:814-446-4209
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-003436-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4556169OtherAETNA PROVIDER #
PA56-24-90789OtherTAX ID
PAP00209792OtherMEDICARE RAILROAD INDIVID
PA56-2490789OtherUMWA ID
PAOS-003436-LOtherPA STATE LICENSE
PA00150773800/01Medicaid
PA255520OtherHEALTH ASSURANCE
PADD1268OtherMEDICARE RAILROAD GROUP#
PA01586199OtherBLUE CROSS/BLUE SHIELD
PA100236OtherUPMC HEALTH PLAN
PA207QOOOOOXOtherTAXONOMY CODE
PA4556169OtherAETNA PROVIDER #
PAB35010Medicare UPIN