Provider Demographics
NPI:1144320524
Name:AHEARN, EILEEN (MD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:AHEARN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 UNIVERSITY AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3750
Mailing Address - Country:US
Mailing Address - Phone:608-263-0572
Mailing Address - Fax:
Practice Address - Street 1:VA HOSPITAL
Practice Address - Street 2:2500 OVERLOOK TERRACE
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705
Practice Address - Country:US
Practice Address - Phone:608-280-7084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI443862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry