Provider Demographics
NPI:1447211339
Name:EISENMAN, SUSAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:EISENMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 HOSPITAL ROAD; PO BOX 788
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-0788
Mailing Address - Country:US
Mailing Address - Phone:724-357-7121
Mailing Address - Fax:724-357-7479
Practice Address - Street 1:835 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-0788
Practice Address - Country:US
Practice Address - Phone:724-357-7009
Practice Address - Fax:724-357-7414
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-043141-L2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012946570000Medicaid
PA253228OtherUPMC
PA457488OtherBLUE SHIELD
PA457488YJOMedicare UPIN
PA125184YJSMedicare PIN
C33893Medicare UPIN
PA253228OtherUPMC
PA0012946570000Medicaid
1457488Medicare ID - Type Unspecified