Provider Demographics
NPI:1043211048
Name:EICHNER, WILLIAM MALCOLM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MALCOLM
Last Name:EICHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4349
Mailing Address - Country:US
Mailing Address - Phone:330-821-0437
Mailing Address - Fax:330-821-0392
Practice Address - Street 1:1640 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4349
Practice Address - Country:US
Practice Address - Phone:330-821-0437
Practice Address - Fax:330-821-0392
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049813E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0540032Medicare PIN