Provider Demographics
NPI:1114182110
Name:EISENSTADT, NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:EISENSTADT
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 1:512 SABINE CIR
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1316
Mailing Address - Country:US
Mailing Address - Phone:610-416-3497
Mailing Address - Fax:
Practice Address - Street 1:512 SABINE CIR
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1316
Practice Address - Country:US
Practice Address - Phone:610-649-0149
Practice Address - Fax:610-649-6031
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014009101Y00000X
PAMD037348E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40586Medicare UPIN