Provider Demographics
NPI:1215224183
Name:EISENHUTH, BEVERLY ANN (DO)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:EISENHUTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:ANN
Other - Last Name:DAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1991 SPROUL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3512
Mailing Address - Country:US
Mailing Address - Phone:610-325-1350
Mailing Address - Fax:610-325-1357
Practice Address - Street 1:1991 SPROUL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3512
Practice Address - Country:US
Practice Address - Phone:610-325-1350
Practice Address - Fax:610-325-1357
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017289207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology