Provider Demographics
NPI:1134226020
Name:EISENBERG, SUSAN JUDITH (MD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JUDITH
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WOODLAND RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9562
Mailing Address - Country:US
Mailing Address - Phone:707-963-7200
Mailing Address - Fax:
Practice Address - Street 1:6 WOODLAND RD STE 304
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9562
Practice Address - Country:US
Practice Address - Phone:707-963-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG065056207RC0001X
CAG65056207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA036290OtherHILL PHYSICIANS PROVIDER
CAG65056Medicaid
CAP01474554OtherRAILROAD MEDICARE (JMH)
CAGR0098120Medicaid
CADB0077OtherMC RAIL ROAD GROUP NUMBER
F19243Medicare UPIN
CA00G650560Medicare ID - Type Unspecified
CAGR0098120Medicaid
CAG65056Medicaid