Provider Demographics
NPI:1962413443
Name:EICHBAUM, ELDAN B (MD)
Entity type:Individual
Prefix:
First Name:ELDAN
Middle Name:B
Last Name:EICHBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MOWRY AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1605
Mailing Address - Country:US
Mailing Address - Phone:510-818-1160
Mailing Address - Fax:510-818-1195
Practice Address - Street 1:2500 MOWRY AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1605
Practice Address - Country:US
Practice Address - Phone:510-818-1160
Practice Address - Fax:510-818-1195
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG75775207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0030300Medicaid
CA00G757750Medicare ID - Type Unspecified
CAGR0030300Medicaid