Provider Demographics
NPI:1447231378
Name:ESHBACH, TED BRUBAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:BRUBAKER
Last Name:ESHBACH
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 1:761 JOHNSONBURG RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3483
Mailing Address - Country:US
Mailing Address - Phone:814-834-1686
Mailing Address - Fax:814-834-6291
Practice Address - Street 1:761 JOHNSONBURG RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3483
Practice Address - Country:US
Practice Address - Phone:814-834-1686
Practice Address - Fax:814-834-6291
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016688E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00820642Medicaid
B40245Medicare UPIN
PA00820642Medicaid