1427221530 NPI number — ESHAM MEDICAL

Table of content: (NPI 1427221530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427221530 NPI number — ESHAM MEDICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESHAM MEDICAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427221530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 SILVERSIDE RD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810-3719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-478-2223
Provider Business Mailing Address Fax Number:
302-478-2246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 SILVERSIDE RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-3719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-478-2223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ESHAM
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
302-478-2223

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  C1-0003508 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0402157 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000384501 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136689 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57372 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 856371 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0507661000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110111640 . This is a "METRAHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 4291985 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 531E74 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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