Provider Demographics
NPI:1972188985
Name:ECKENRODE, ISIAH SCOTT
Entity Type:Individual
Prefix:
First Name:ISIAH
Middle Name:SCOTT
Last Name:ECKENRODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-3656
Mailing Address - Country:US
Mailing Address - Phone:304-695-4048
Mailing Address - Fax:
Practice Address - Street 1:644 S 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-3656
Practice Address - Country:US
Practice Address - Phone:304-695-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant