Provider Demographics
NPI:1336535632
Name:EICHELBERGER, IMANI RENE (MD)
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:RENE
Last Name:EICHELBERGER
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 1:23 MANHATTAN SQ
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5843
Mailing Address - Country:US
Mailing Address - Phone:757-668-2200
Mailing Address - Fax:757-668-2222
Practice Address - Street 1:23 MANHATTAN SQ
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5843
Practice Address - Country:US
Practice Address - Phone:757-668-2200
Practice Address - Fax:757-668-2222
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty