Provider Demographics
NPI:1356365761
Name:RECKO, RICHARD R (DPM, PA)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:RECKO
Suffix:
Gender:M
Credentials:DPM, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 WELLINGTON AVE SUITE 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6075
Mailing Address - Country:US
Mailing Address - Phone:910-762-2404
Mailing Address - Fax:910-762-4249
Practice Address - Street 1:1776 WELLINGTON AVE SUITE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6075
Practice Address - Country:US
Practice Address - Phone:910-762-2404
Practice Address - Fax:910-762-4249
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC213213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08139OtherBCBS
NCDD0367OtherRAILROAD M'CARE
NC7908139Medicaid
5400810001OtherMEDICARE DME
NC2345943Medicare PIN
NC08139OtherBCBS
NC243120AMedicare PIN