Provider Demographics
NPI:1295797124
Name:ESCHBACH, KELLY S (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:ESCHBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WEST 14TH ST
Mailing Address - Street 2:6TH FLOOR REHAB
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801
Mailing Address - Country:US
Mailing Address - Phone:302-428-6600
Mailing Address - Fax:302-428-6750
Practice Address - Street 1:4735 OGLETOWN-STANTON RD
Practice Address - Street 2:STE 2210
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:302-623-4147
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI0004591208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2114908OtherUNITED HEALTH CARE
DE0000646701Medicaid
DE2114908OtherUNITED HEALTH CARE
G15507Medicare UPIN