Provider Demographics
NPI:1619914355
Name:EICHBAUM, QUENTIN G (MD PHD, MPH, MMED,)
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:G
Last Name:EICHBAUM
Suffix:
Gender:M
Credentials:MD PHD, MPH, MMED,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ELM AND CARLTON ST STE 5075TH
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:716-845-8622
Mailing Address - Fax:
Practice Address - Street 1:ELM AND CARLTON ST STE 5075TH
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339205207ZB0001X
TNMD46916207ZB0001X, 207ZP0102X
MA226122207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine