Provider Demographics
NPI:1912995812
Name:ESHAM, GEORGE ELWOOD (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELWOOD
Last Name:ESHAM
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:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:606-408-3719
Practice Address - Street 1:2001 SCIOTO TRL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2845
Practice Address - Country:US
Practice Address - Phone:740-354-7769
Practice Address - Fax:740-353-8978
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH47366207R00000X
AL00007427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
146004000OtherOH DEPT OF LABOR
521305469001OtherMEDICAL MUTUAL
0004276065OtherAETNA PIN #
OH64781172Medicaid
OH0488360Medicaid
52130546900OtherOH BUREAU W/C
5213054690010OtherCIGNA
OH000000152205OtherANTHEM
OH000000152205OtherANTHEM
A15102Medicare UPIN