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NPI Code Detail

MEDICARE: MADELYN GRACE EICHENLAUB PA

MEDICARE: MADELYN GRACE EICHENLAUB PA
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
1363A00000XPhysician Assistant0110010679VA

General Provider Information

NPI Number : 1174329270
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELYN GRACE EICHENLAUB PA
Provider Business Mailing Address
First Line : 225 CLEARFIELD AVE
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-1815
Country : US
Telephone Number : 757-457-5100
Fax Number : 757-457-5100
Provider Business Practice Location Address
First Line : 225 CLEARFIELD AVE
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-1815
Country : US
Telephone Number : 757-457-5100
Fax Number : 757-961-3696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2025
Last Update Date : 04/15/2026

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Directions to “ MADELYN GRACE EICHENLAUB PA” Practice Location

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