Provider Demographics
NPI:1902860554
Name:EAKIN, ELIANE FESTA (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIANE
Middle Name:FESTA
Last Name:EAKIN
Suffix:
Gender:F
Credentials:MD PHD
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:484-628-1324
Mailing Address - Fax:
Practice Address - Street 1:160 E ERIE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1011
Practice Address - Country:US
Practice Address - Phone:484-628-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC145488208000000X, 2080P0214X
ALMD.438552080P0214X
PAMD068646L2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09532791Medicaid
OK200469830AMedicaid
MI5176212Medicaid
MI3503313501OtherBLUE CROSS BLUE SHIEL
MS350C360920OtherBCBS OF MS
OK200469830AMedicaid
MI3503313501OtherBLUE CROSS BLUE SHIEL
MSH53691Medicare UPIN