Provider Demographics
NPI:1174534093
Name:ECKELMAN, JOHN DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:ECKELMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 CEDARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-3613
Mailing Address - Country:US
Mailing Address - Phone:781-820-4600
Mailing Address - Fax:781-741-8341
Practice Address - Street 1:62 DERBY ST
Practice Address - Street 2:STE 13
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-749-4600
Practice Address - Fax:781-741-8341
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0516937Medicaid
MA720120OtherTUFTS HEALTH PLAN
MA4200242OtherAETNA
MA005705OtherVALUE OPTIONS
MAECW03181OtherBLUE CROSS BLUE SHIELD
MA04343088005OtherPACIFICARE
MA32502MSOtherHARVARD PILGRIM HEALTH CA
MAECW03181OtherBLUE CROSS BLUE SHIELD