Provider Demographics
NPI:1235156282
Name:DAVID E EISENBERG MD PC
Entity Type:Organization
Organization Name:DAVID E EISENBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-884-0456
Mailing Address - Street 1:111 EVERETT AVE
Mailing Address - Street 2:STE 2C
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150
Mailing Address - Country:US
Mailing Address - Phone:617-884-0456
Mailing Address - Fax:617-884-0457
Practice Address - Street 1:111 EVERETT AVE
Practice Address - Street 2:STE 2C
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150
Practice Address - Country:US
Practice Address - Phone:617-884-0456
Practice Address - Fax:617-884-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36137207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15163OtherHARVARD PILGRIM
MA9746595Medicaid
MA15163OtherHARVARD PILGRIM
MA4278580001Medicare NSC