Provider Demographics
NPI:1427221530
Name:ESHAM MEDICAL
Entity type:Organization
Organization Name:ESHAM MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-478-2223
Mailing Address - Street 1:2700 SILVERSIDE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-2223
Mailing Address - Fax:302-478-2246
Practice Address - Street 1:2700 SILVERSIDE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3719
Practice Address - Country:US
Practice Address - Phone:302-478-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0402157OtherUNITED HEALTHCARE
DE0000384501Medicaid
136689OtherMEDICARE PTAN
57372OtherCOVENTRY
856371OtherOPTIMUM CHOICE
0507661000OtherAMERIHEALTH
DE110111640OtherMETRAHEALTH
4291985OtherAETNA
DE531E74OtherBLUE CROSS BLUE SHIELD OF
4291985OtherAETNA