Provider Demographics
NPI:1821014820
Name:EISENBERG, ROBERT B (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR
Mailing Address - Street 2:#501
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:619-697-2456
Mailing Address - Fax:
Practice Address - Street 1:1541 FLORIDA AVE
Practice Address - Street 2:#100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4429
Practice Address - Country:US
Practice Address - Phone:209-577-3388
Practice Address - Fax:209-338-0024
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK115XOtherMEDICARE PTAN FOR GHP
CA1982938247Medicaid
CAWA43540COtherMEDICARE PTAN FOR GHP
CAWA43540COtherMEDICARE PTAN FOR GHP
CACK115ZMedicare PIN