Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 016500 | CT |
NPI | 1104920388 |
---|---|
Provider Name | Kenneth L Eckhart |
First Address | Middletown, CT 06457-4711 |
Second Address | Middletown, CT 06457-4711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 05/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001165001 | (05) | CT |
B39306 | (02) |