MEDICARE: DR. SHANE EIKENBERRY M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	MD466758	PA

General Provider Information

NPI Number	:	1528421443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE EIKENBERRY M.D.

Provider Business Mailing Address
First Line	:	193 43RD ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15201-3166
Country	:	US
Telephone Number	:	412-621-5227
Fax Number	:	412-681-4524

Provider Business Practice Location Address
First Line	:	193 43RD ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15201-3166
Country	:	US
Telephone Number	:	412-621-5227
Fax Number	:	412-681-4524

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

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	10/28/2019

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