Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | MD021034E | PA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD021034E | PA |
NPI | 1659438372 |
---|---|
Provider Name | Herbert A Ecker JR. |
First Address | Williamsport, PA 17701-6151 |
Second Address | Williamsport, PA 17701-6151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 19/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132338 | BLUE SHIELD (01) | PA |
B37793 | (02) | PA |