Basic Information
| Provider Information | |||||||||
| NPI: | 1447231378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESHBACH | ||||||||
| FirstName: | TED | ||||||||
| MiddleName: | BRUBAKER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 761 JOHNSONBURG RD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ST MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158573483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148341686 | ||||||||
| FaxNumber: | 8148346291 | ||||||||
| Practice Location | |||||||||
| Address1: | 761 JOHNSONBURG RD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ST MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158573483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148341686 | ||||||||
| FaxNumber: | 8148346291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 11/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD016688E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00820642 | 05 | PA | MEDICAID |