Provider Demographics
NPI:1730264094
Name:GEORGE E. ESHAM, M.D. INC.
Entity type:Organization
Organization Name:GEORGE E. ESHAM, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-354-7769
Mailing Address - Street 1:1735 27TH ST STE 309
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2679
Mailing Address - Country:US
Mailing Address - Phone:740-354-7769
Mailing Address - Fax:740-353-8978
Practice Address - Street 1:1735 27TH ST STE 309
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2679
Practice Address - Country:US
Practice Address - Phone:740-354-7769
Practice Address - Fax:740-353-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH47366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64781172Medicaid
OH0488360Medicaid
OH110003365Medicare PIN
OH0488360Medicaid
OHA15102Medicare UPIN