Basic Information
| Provider Information | |||||||||
| NPI: | 1467480475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EICHHORN | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4071 TATES CREEK CENTRE DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405173062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592604330 | ||||||||
| FaxNumber: | 8592604334 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592604330 | ||||||||
| FaxNumber: | 8592604334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 11/13/2013 | ||||||||
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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 | 2084N0400X | 39152 | KY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084S0012X | 39152 | KY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64096720 | 05 | KY | MEDICAID |