Provider Demographics
NPI:1528421443
Name:EIKENBERRY, SHANE (MD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:EIKENBERRY
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 1:193 43RD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-3166
Mailing Address - Country:US
Mailing Address - Phone:412-621-5227
Mailing Address - Fax:412-681-4524
Practice Address - Street 1:193 43RD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-3166
Practice Address - Country:US
Practice Address - Phone:412-621-5227
Practice Address - Fax:412-681-4524
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD466758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program