Basic Information
| Provider Information | |||||||||
| NPI: | 1831216746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EICHENBAUM | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 LIMESTONE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026559494 | ||||||||
| FaxNumber: | 3026333559 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 BRANDYWINE PKWY | ||||||||
| Address2: | STE101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198031554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026559494 | ||||||||
| FaxNumber: | 3024791559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
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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 | MD432176 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | C1-0009482 | DE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | C1-0009482 | DE | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1831216746 | 05 | DE | MEDICAID | 3810352000 | 01 | DE | AMERIHEALTH/IBX/KEYSTONE | OTHER | 9128542 | 01 | DE | AETNA | OTHER | P00908709 | 01 | DE | RAILROAD MEDICARE | OTHER |