Provider Demographics
NPI:1003818196
Name:EISENMAN, DAVID JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFREY
Last Name:EISENMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S EUTAW ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1606
Mailing Address - Country:US
Mailing Address - Phone:410-328-5828
Mailing Address - Fax:410-328-5827
Practice Address - Street 1:16 S EUTAW ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1606
Practice Address - Country:US
Practice Address - Phone:410-328-5828
Practice Address - Fax:410-328-5827
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33236207Y00000X
MDD58315207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0008988C93Medicare ID - Type Unspecified
H54777Medicare UPIN