Provider Demographics
NPI:1073932091
Name:FICHTENBAUM, ERIC JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JACOB
Last Name:FICHTENBAUM
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-276-3707
Mailing Address - Fax:513-558-3474
Practice Address - Street 1:500 E MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5369
Practice Address - Country:US
Practice Address - Phone:614-544-9670
Practice Address - Fax:614-544-9671
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA162397208800000X
OH35.1396815208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology