Provider Demographics
NPI:1619442464
Name:ESHBAUGH, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ESHBAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH FORK
Mailing Address - State:PA
Mailing Address - Zip Code:15956-3503
Mailing Address - Country:US
Mailing Address - Phone:814-691-0371
Mailing Address - Fax:
Practice Address - Street 1:806 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH FORK
Practice Address - State:PA
Practice Address - Zip Code:15956-3503
Practice Address - Country:US
Practice Address - Phone:814-691-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty