Provider Demographics
NPI:1508899154
Name:JAXHEIMER, ERIC C (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:JAXHEIMER
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 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 1070
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:484-628-2468
Practice Address - Fax:484-628-2467
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029617E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102264305Medicaid
PA102264305Medicaid
PA111253Medicare PIN