Provider Demographics
NPI:1427041151
Name:EISEN, DRORE (MD)
Entity Type:Individual
Prefix:DR
First Name:DRORE
Middle Name:
Last Name:EISEN
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 1:10506 MONTGOMERY RD
Mailing Address - Street 2:#402
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4487
Mailing Address - Country:US
Mailing Address - Phone:513-791-6161
Mailing Address - Fax:
Practice Address - Street 1:10506 MONTGOMERY RD
Practice Address - Street 2:#402
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4487
Practice Address - Country:US
Practice Address - Phone:513-791-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9790207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0866102Medicaid
OHE19530Medicare UPIN
OH0866102Medicaid