MEDICARE: GEORGE ELWOOD ESHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	47366	OH
2	207R00000X	Internal Medicine Physician	00007427	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	146004000	OTHER		OH DEPT OF LABOR
2	521305469001	OTHER		MEDICAL MUTUAL
3	0004276065	OTHER		AETNA PIN #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	52130546900	OTHER		OH BUREAU W/C
7	5213054690010	OTHER		CIGNA
8	000000152205	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1912995812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE ELWOOD ESHAM MD

Provider Business Mailing Address
First Line	:	PO BOX 1595
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41105-1595
Country	:	US
Telephone Number	:	606-408-4000
Fax Number	:	606-408-3719

Provider Business Practice Location Address
First Line	:	2001 SCIOTO TRL
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-2845
Country	:	US
Telephone Number	:	740-354-7769
Fax Number	:	740-353-8978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	04/11/2012

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