Provider Demographics
NPI:1497768568
Name:ESHBAUGH, DENNIS M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:ESHBAUGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 FRALEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7542
Mailing Address - Country:US
Mailing Address - Phone:614-538-1215
Mailing Address - Fax:614-538-1214
Practice Address - Street 1:2280 HENDERSON RD
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-7344
Practice Address - Country:US
Practice Address - Phone:614-538-1215
Practice Address - Fax:614-538-1214
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2538103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0417249Medicaid
OHD CP20621Medicare ID - Type Unspecified