Provider Demographics
NPI:1760421507
Name:EISENBERG, HOWARD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:MICHAEL
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64315
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4315
Mailing Address - Country:US
Mailing Address - Phone:410-328-8209
Mailing Address - Fax:410-328-1413
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:S12D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-8209
Practice Address - Fax:410-328-1413
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD43894207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
460L295CMedicare PIN
MDB75789Medicare UPIN