Provider Demographics
NPI:1942281100
Name:ECKEL, TIMOTHY S (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:ECKEL
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 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2770
Mailing Address - Fax:410-841-6251
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 235
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2770
Practice Address - Fax:410-841-6251
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00439462085N0700X, 2085R0204X
PAMD061170L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10690022OtherBCBS
MDCK4885OtherGROUP PTAN BOWIE
MDA01OtherAAD PG COUNTY
MD557WOtherAAD SHIPLEYS
MD556WOtherAAD AA COUNTY
MD8317071OtherAETNA PPO
MD2622593OtherAETNA HMO/POS
MD840200100Medicaid
MDP00442257OtherPTAN BOWIE
MD2622593OtherAETNA HMO/POS
MD8317071OtherAETNA PPO
MDG21373Medicare UPIN
MDS629140XMedicare ID - Type Unspecified
MD300087692Medicare PIN