Provider Demographics
NPI:1649345513
Name:EISEN, MARC D (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:EISEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:40 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2454
Mailing Address - Country:US
Mailing Address - Phone:860-640-4455
Mailing Address - Fax:860-640-4478
Practice Address - Street 1:40 STANFORD DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2454
Practice Address - Country:US
Practice Address - Phone:860-640-4455
Practice Address - Fax:860-640-4478
Is Sole Proprietor?:No
Enumeration Date:2006-11-23
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT045054207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I67755Medicare UPIN