Provider Demographics
NPI:1760552228
Name:EICHHORN, JENS (MD)
Entity Type:Individual
Prefix:
First Name:JENS
Middle Name:
Last Name:EICHHORN
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 FAULK ST
Practice Address - Street 2:STE 3100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5086
Practice Address - Country:US
Practice Address - Phone:704-667-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01855207RC0000X, 207R00000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1516Medicaid
NC1760552228Medicaid
NC5914190Medicaid
CAP00420860OtherRAILROAD MEDICARE
CA00A783450OtherBLUE SHIELD
CA00A783450Medicaid
CA00A783450Medicaid
CABU071ZMedicare PIN
NC1760552228Medicaid
NC2075440Medicare PIN
CAH63349Medicare UPIN
CABU071YMedicare PIN
SCNC1516Medicaid
NCNC3504AMedicare PIN
SCSC45128186Medicare PIN