Provider Demographics
NPI:1932140019
Name:ENZINGER, EVA M (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:M
Last Name:ENZINGER
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 1:5 BARTER CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03905-5611
Mailing Address - Country:US
Mailing Address - Phone:207-992-7001
Mailing Address - Fax:207-439-4793
Practice Address - Street 1:750 CENTRAL AVE STE L
Practice Address - Street 2:CENTRAL COMMONS
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3434
Practice Address - Country:US
Practice Address - Phone:207-992-7001
Practice Address - Fax:207-439-4793
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11732207Q00000X
ME015882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH58692Medicare UPIN
MEMM9531Medicare PIN