Provider Demographics
NPI:1366650038
Name:EISENBERG, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:EISENBERG
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 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-696-2040
Mailing Address - Fax:860-696-2050
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 700
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-696-2040
Practice Address - Fax:860-696-2050
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431341208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT047715OtherCONNECTICARE
CT9956346OtherAETNA
CT1366650038Medicaid
CTP4028960OtherOXFORD
CT46291OtherHEALTH NEW ENGLAND
CT061200871OtherCIGNA
CT061200871OtherMULTIPLAN
CT1366650038Medicaid