Provider Demographics
NPI:1104203793
Name:EISEN, ERIC ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANDREW
Last Name:EISEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1231 116TH AVE NE STE 930
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3804
Mailing Address - Country:US
Mailing Address - Phone:425-688-1916
Mailing Address - Fax:425-688-1901
Practice Address - Street 1:1231 116TH AVE NE STE 930
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3804
Practice Address - Country:US
Practice Address - Phone:425-688-1916
Practice Address - Fax:425-688-1901
Is Sole Proprietor?:No
Enumeration Date:2015-05-03
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61047604207YX0007X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2160928Medicaid
WA427413OtherWA L&I