Provider Demographics
NPI:1891789046
Name:EISDORFER, ROBERT MARK (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:EISDORFER
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 1:14955 SHADY GROVE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8700
Mailing Address - Country:US
Mailing Address - Phone:301-340-3252
Mailing Address - Fax:301-340-1423
Practice Address - Street 1:14955 SHADY GROVE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8700
Practice Address - Country:US
Practice Address - Phone:301-340-3252
Practice Address - Fax:301-340-1423
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041731207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD597761400Medicaid
MD100005281OtherRAILROAD MEDICARE
MDEI685690Medicare ID - Type Unspecified
MD597761400Medicaid