Provider Demographics
NPI:1487628418
Name:EISENBERG, MARK PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PHILIP
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-8135
Mailing Address - Fax:617-724-8010
Practice Address - Street 1:15 FRUIT ST
Practice Address - Street 2:MGH
Practice Address - City:FRUIT ST
Practice Address - State:MA
Practice Address - Zip Code:02114-3026
Practice Address - Country:US
Practice Address - Phone:617-724-8135
Practice Address - Fax:617-724-8010
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-09-23
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Provider Licenses
StateLicense IDTaxonomies
MA54761207RA0401X, 207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA054761OtherTUFTS HEALTH PLAN
MA3013103Medicaid
MAJ05654OtherBCBS MA
MA054761OtherTUFTS HEALTH PLAN
D82917Medicare UPIN