Provider Demographics
NPI:1992700728
Name:EISEN, RICHARD FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:FRANKLIN
Last Name:EISEN
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 1:801 ALBANY ST FL G
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY ST # 8B
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3549
Practice Address - Country:US
Practice Address - Phone:617-638-7420
Practice Address - Fax:617-638-7289
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48498207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA37336OtherUNICARE
MA4274478OtherAETNA
MA03-00291OtherUNITED HEALTHCARE
MA4032OtherHARVARD PILGRIM
MA509211OtherFALLON HEALTHCARE
MAB202877OtherCIGNA HEALTHCARE
MA712907OtherTUFTS HEALTH PLAN
MAE05971OtherBLUE CROSS/BLUE SHIELD
MA37336OtherUNICARE
MAE05971OtherBLUE CROSS/BLUE SHIELD