Provider Demographics
NPI:1811948565
Name:EISENHOWER-TURNER, EDITH SUSANNA (MD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:SUSANNA
Last Name:EISENHOWER-TURNER
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 1:1098 W. BALTIMORE PIKE
Mailing Address - Street 2:OP PAVILION, SUITE 3311
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-299-6447
Mailing Address - Fax:610-565-1425
Practice Address - Street 1:1098 W. BALTIMORE PIKE
Practice Address - Street 2:OP PAVILION, SUITE 3311
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-299-6447
Practice Address - Fax:610-565-1425
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021337E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA416502Medicare ID - Type Unspecified