Provider Demographics
NPI:1619947249
Name:EISENBERG, STUART (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:EISENBERG
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 1:15 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1156
Mailing Address - Country:US
Mailing Address - Phone:207-647-6240
Mailing Address - Fax:207-641-6223
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1156
Practice Address - Country:US
Practice Address - Phone:207-647-6240
Practice Address - Fax:207-647-6223
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016650207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME415690099Medicaid
ME432706124Medicaid
MEDC0798OtherRAILROAD MEDICARE
ME415690099Medicaid
MEME090002Medicare PIN
ME432706124Medicaid