Provider Demographics
NPI:1770580128
Name:EAKIN, STEPHEN W (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:EAKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1280A MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-1465
Practice Address - Country:US
Practice Address - Phone:434-309-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
45207OtherSENTARA/OPTIMA PROVIDER N
700010640OtherCIGNA PROVIDER NUMBER
186412OtherANTHEM PROVIDER NUMBER
203639329OtherUNITED HEALTHCARE PROVIDE
VA010215072Medicaid
203639329OtherPCHP PROVIDER NUMBER
203639329013OtherTRICARE PROVIDER NUMBER
010215072OtherVA PREMIER
329078OtherSOUTHERN HEALTH PROVIDER
47475OtherMEDCOST PROVIDER NUMBER
P00293878Medicare PIN
203639329013OtherTRICARE PROVIDER NUMBER
B60017Medicare UPIN