Provider Demographics
NPI:1982656484
Name:EISENBERG, ALAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:EISENBERG
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:PO BOX 5083
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-5083
Mailing Address - Country:US
Mailing Address - Phone:877-448-8679
Mailing Address - Fax:901-383-8985
Practice Address - Street 1:7600 WOLF RIVER BLVD
Practice Address - Street 2:STE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1784
Practice Address - Country:US
Practice Address - Phone:901-747-1000
Practice Address - Fax:901-383-8985
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3062300Medicaid
TN132605OtherTN BCBS
AR96065OtherAR BCBS
MS0116070Medicaid
AR120412001Medicaid
TN300046961Medicare ID - Type UnspecifiedTN RR M'CARE
TN132605OtherTN BCBS
TN3062301Medicare ID - Type UnspecifiedTN M'CARE
MS0116070Medicaid