Provider Demographics
NPI:1295870749
Name:ECKER, KELLY L (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:ECKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:DIVISION OF NEONATOLOGY
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-447-6707
Mailing Address - Fax:610-447-6719
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:DIVISION OF NEONATOLOGY
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-447-6707
Practice Address - Fax:610-447-6719
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0152432080N0001X
MDH0069767208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics