Provider Demographics
NPI:1518080639
Name:EISENBERG, REBECCA L (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:EISENBERG
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 1:27 INDUSTRIAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-5846
Mailing Address - Country:US
Mailing Address - Phone:207-459-1666
Mailing Address - Fax:
Practice Address - Street 1:27 INDUSTRIAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-5846
Practice Address - Country:US
Practice Address - Phone:207-294-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231351207RH0003X
NH17501207RX0202X
MEMD23794207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA496421OtherTUFTS
MA8613966OtherCIGNA
MA7941952OtherAETNA
MAAA96705OtherHARVARD PILGRIM
MAJ42096OtherBLUE CROSS LEGACY #
MAAA96705OtherHARVARD PILGRIM