Basic Information
| Provider Information | |||||||||
| NPI: | 1962564484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ECCLES | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6900 GEORGIA AVE NW | ||||||||
| Address2: | WRAMC BLDG 2 ROOM 2J38 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027826107 | ||||||||
| FaxNumber: | 2027820740 | ||||||||
| Practice Location | |||||||||
| Address1: | 6900 GEORGIA AVE NW | ||||||||
| Address2: | WRAMC BLDG 2 DEPARTMENT OF PEDIATRICS | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027826107 | ||||||||
| FaxNumber: | 2027820740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D0056915 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.