Provider Demographics
NPI:1609114081
Name:EISENFELD, RACHEL FANNELL (C-PED, OF)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:FANNELL
Last Name:EISENFELD
Suffix:
Gender:F
Credentials:C-PED, OF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10660 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4098
Mailing Address - Country:US
Mailing Address - Phone:703-350-4871
Mailing Address - Fax:
Practice Address - Street 1:10660 PAGE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4098
Practice Address - Country:US
Practice Address - Phone:703-350-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-20
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist