Provider Demographics
NPI:1013943026
Name:EISENBERG, RONALD LEE (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
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 1:330 BROOKLINE AVE
Mailing Address - Street 2:EICC4 BIDMC-DEPT. OF RADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-0662
Mailing Address - Fax:617-667-0665
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:ECC4 BIDMC-DEPT. OF RADIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-0662
Practice Address - Fax:617-667-0665
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24216174400000X
MA2338062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB60862Medicare UPIN