Healthcare Provider Details

I. General information

NPI: 1619914355
Provider Name (Legal Business Name): QUENTIN G EICHBAUM M.D. PHD, MPH, MMED,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON ST STE 5075TH
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

ELM AND CARLTON ST STE 5075TH
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-8622
  • Fax:
Mailing address:
  • Phone: 716-845-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number339205
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberMD46916
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number226122
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD46916
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: