Provider Demographics
NPI:1336128719
Name:EICHELBERGER, DWIGHT O (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:O
Last Name:EICHELBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:418 CLOVERLEAF RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9320
Mailing Address - Country:US
Mailing Address - Phone:717-653-1467
Mailing Address - Fax:717-653-1001
Practice Address - Street 1:418 CLOVERLEAF RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9320
Practice Address - Country:US
Practice Address - Phone:717-653-1467
Practice Address - Fax:717-653-1001
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD424587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP006466OtherGATEWAY HEALTH PLAN
PA3628851OtherAETNA HMO
PA50053533OtherCAPITAL BLUE CROSS
PA805335OtherHIGHMARK BLUE SHIELD
PAF56379OtherHEALTH ASSURANCE
PA5397699OtherAETNA NON-HMO
PA93183 S101OtherGEISINGER HEALTH PLAN
PA1010970330002Medicaid
PAP00267525OtherRAILROAD MEDICARE
PA1010970330002Medicaid
PA082022L4VMedicare PIN