Provider Demographics
NPI:1811990674
Name:EISLEY, JOHN CHARLES (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:EISLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:447 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-2564
Mailing Address - Country:US
Mailing Address - Phone:724-258-2070
Mailing Address - Fax:724-258-3582
Practice Address - Street 1:447 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-2564
Practice Address - Country:US
Practice Address - Phone:724-258-2070
Practice Address - Fax:724-258-3582
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003714L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0075062OtherAETNA
PA0B29927OtherHEALTH AMERICA HMO
PA0010778890002Medicaid
PA0B29927OtherHEALTH ASSURANCE
PA303978OtherUPMC
PA88888OtherUNISON HEALTH CARE
PA0B29927OtherHEALTH AMERICA ADVANTRA
PA1811990674OtherNPI
PA53859OtherUNITED HEALTHCARE
PA1811990674OtherNPI
PA0B29927OtherHEALTH AMERICA HMO