Provider Demographics
NPI:1790785665
Name:HARRAHILL, EILEEN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:MARIE
Last Name:HARRAHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12700 SOUTHFORK RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3201
Mailing Address - Country:US
Mailing Address - Phone:314-525-4971
Mailing Address - Fax:314-525-4972
Practice Address - Street 1:12700 SOUTHFORK RD
Practice Address - Street 2:SUITE 290
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3201
Practice Address - Country:US
Practice Address - Phone:314-525-4971
Practice Address - Fax:314-525-4972
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3L45207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208280909Medicaid
MO331025621Medicare PIN
MO208280909Medicaid