Provider Demographics
NPI:1548217490
Name:EISENBEIS, CHARLES FREDRICK (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FREDRICK
Last Name:EISENBEIS
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 1:150 PARKWAY OFFICE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-0002
Mailing Address - Country:US
Mailing Address - Phone:984-974-2150
Mailing Address - Fax:984-974-2151
Practice Address - Street 1:150 PARKWAY OFFICE CT STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-0002
Practice Address - Country:US
Practice Address - Phone:984-974-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01835207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903326Medicaid
NC5903326Medicaid
NC2049694AMedicare PIN