Provider Demographics
NPI:1972834836
Name:EISENBERG, HARVEY CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:CHARLES
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2722 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7048
Mailing Address - Country:US
Mailing Address - Phone:949-717-4500
Mailing Address - Fax:714-689-3519
Practice Address - Street 1:2722 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7048
Practice Address - Country:US
Practice Address - Phone:949-717-4500
Practice Address - Fax:714-689-3519
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG378162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology