Healthcare Provider Details

I. General information

NPI: 1396701082
Provider Name (Legal Business Name): JENNIFER EISENMENGER CHARLTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 10/13/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

208 CARTERS GROVE LN
LYNCHBURG VA
24503-2125
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-2300
  • Fax:
Mailing address:
  • Phone: 434-258-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101221476
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: