Provider Demographics
NPI:1851481626
Name:EICHELMAN, JUTTA M (MD)
Entity Type:Individual
Prefix:
First Name:JUTTA
Middle Name:M
Last Name:EICHELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUTTA
Other - Middle Name:MARGARETE
Other - Last Name:ECKERT-EICHELMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17 N HERITAGE WOODS LN
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-3238
Mailing Address - Country:US
Mailing Address - Phone:207-395-2590
Mailing Address - Fax:207-395-2077
Practice Address - Street 1:AUGUSTA NEUROLOGY, PA
Practice Address - Street 2:17 NORTH HERITAGE WOODS LANE
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-5728
Practice Address - Country:US
Practice Address - Phone:207-395-2590
Practice Address - Fax:207-395-2077
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0137952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEF93655Medicare UPIN
MEMM5491Medicare ID - Type Unspecified