Provider Demographics
NPI:1952306904
Name:ESBERG, DOUGLAS B (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:ESBERG
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 1:100 E LANCASTER AVE
Mailing Address - Street 2:JD LANKENAU PAVILION
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-476-1000
Mailing Address - Fax:484-476-9000
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:JD LANKENAU PAVILION
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-1000
Practice Address - Fax:484-476-9000
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061290L207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG18448Medicare UPIN
PA050443F7EMedicare ID - Type UnspecifiedMEDICARE
PA0018878510001Medicaid
PA050443HK1Medicare PIN