Provider Demographics
NPI:1467458968
Name:EBERT, EILEEN D II (DO)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:D
Last Name:EBERT
Suffix:II
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1475 TANEY AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5126
Mailing Address - Country:US
Mailing Address - Phone:301-662-0133
Mailing Address - Fax:240-379-6710
Practice Address - Street 1:1475 TANEY AVE
Practice Address - Street 2:STE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5126
Practice Address - Country:US
Practice Address - Phone:301-662-0133
Practice Address - Fax:240-379-6710
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDH00367452080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD209241700Medicaid