Provider Demographics
NPI:1639310139
Name:EISEN, VERONICA (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:EISEN
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 1:160 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5600
Mailing Address - Country:US
Mailing Address - Phone:724-671-1440
Mailing Address - Fax:724-431-1500
Practice Address - Street 1:160 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5600
Practice Address - Country:US
Practice Address - Phone:724-671-1440
Practice Address - Fax:724-431-1500
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4528112085R0001X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102969622Medicaid
PA003058825OtherHIGHMARK
PA102969622Medicaid