Provider Demographics
NPI:1225263858
Name:KIMCHI, EITAN (MD)
Entity Type:Individual
Prefix:
First Name:EITAN
Middle Name:
Last Name:KIMCHI
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 1:5300 ALPHA COMMONS DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2764
Mailing Address - Country:US
Mailing Address - Phone:410-550-1089
Mailing Address - Fax:
Practice Address - Street 1:5300 ALPHA COMMONS DR FL 4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2764
Practice Address - Country:US
Practice Address - Phone:410-550-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00714142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry