Provider Demographics
NPI:1215152202
Name:EICHELBERGER, MARYROSE (MD)
Entity type:Individual
Prefix:DR
First Name:MARYROSE
Middle Name:
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 1:950 INDIAN LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2145
Mailing Address - Country:US
Mailing Address - Phone:410-971-4153
Mailing Address - Fax:
Practice Address - Street 1:950 INDIAN LANDING RD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2145
Practice Address - Country:US
Practice Address - Phone:410-971-4153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42146207R00000X
SCMD88657207R00000X
FLME147909207R00000X
MDF75735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD42126OtherLICENSE
MD531365 05OtherBCBS RENDERING ID
MD00001181183 08OtherUNITED HEALTHCARE
MDD42126OtherLICENSE
MD3196OtherCOVENTRY
MDKJ46BLOtherCAREFIRST BCBS
MD000000214000OtherPHCS
MDD42126OtherLICENSE
MDF75735Medicare UPIN