Provider Demographics
NPI:1972503514
Name:STECKLER, ERIC ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALAN
Last Name:STECKLER
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 1:9000 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3038
Mailing Address - Country:US
Mailing Address - Phone:703-280-2272
Mailing Address - Fax:703-280-1711
Practice Address - Street 1:1483 CHAIN BRIDGE RD STE 304
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5703
Practice Address - Country:US
Practice Address - Phone:703-734-1633
Practice Address - Fax:703-734-6124
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010297672084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1432OtherBLUE CROSS PROVIDER #
VAB93863Medicare UPIN
DC1432OtherBLUE CROSS PROVIDER #