Provider Demographics
NPI:1679639256
Name:EDWARD M. EISENBREY,M.D.,P.A.
Entity Type:Organization
Organization Name:EDWARD M. EISENBREY,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MARSTON
Authorized Official - Last Name:EISENBREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-843-5333
Mailing Address - Street 1:3050 CRAIN HWY
Mailing Address - Street 2:SUITE 301 AND 302
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2824
Mailing Address - Country:US
Mailing Address - Phone:301-843-5333
Mailing Address - Fax:301-870-9988
Practice Address - Street 1:3050 CRAIN HWY
Practice Address - Street 2:SUITE 301 AND 302
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2824
Practice Address - Country:US
Practice Address - Phone:301-843-5333
Practice Address - Fax:301-870-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017291207VG0400X
MDD161802080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF47443Medicare UPIN
MDC62012Medicare UPIN
MD216P484GMedicare ID - Type UnspecifiedEDWARD EISENBREY,MD
MD216PMedicare ID - Type UnspecifiedCORPORATE GROUP #