Basic Information
| Provider Information | |||||||||
| NPI: | 1295797124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESCHBACH | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 WEST 14TH ST | ||||||||
| Address2: | 6TH FLOOR REHAB | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024286600 | ||||||||
| FaxNumber: | 3024286750 | ||||||||
| Practice Location | |||||||||
| Address1: | 4735 OGLETOWN-STANTON RD | ||||||||
| Address2: | STE 2210 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234144 | ||||||||
| FaxNumber: | 3026234147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | CI0004591 | DE | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 2114908 | 01 | DE | UNITED HEALTH CARE | OTHER | 0000646701 | 05 | DE | MEDICAID |