Individual
REBECCA ELECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
635 MAIN ST, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 343-7379
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
049357
CT
208M00000X
Hospitalist Physician
049357
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
01
—
049357
CT LICENSE
CT
Enumeration date
01/21/2008
Last updated
02/13/2012
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