Provider Demographics
NPI:1982613907
Name:EISNER, RICHARD STUART (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STUART
Last Name:EISNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 HIGHLAND AVE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2185
Mailing Address - Country:US
Mailing Address - Phone:978-744-5991
Mailing Address - Fax:978-745-6780
Practice Address - Street 1:55 HIGHLAND AVE
Practice Address - Street 2:SUITE #103
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2185
Practice Address - Country:US
Practice Address - Phone:978-744-5991
Practice Address - Fax:978-745-6780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1666213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33741OtherHPHC
MA480002365OtherRAILROAD MEDICARE
MA0345121Medicaid
MAY70-716OtherBLUE SHIELD NUMBER
MAS010492OtherTRICARE
MA731873OtherTUFTS
MA480002365OtherRAILROAD MEDICARE
MA731873OtherTUFTS
MA0345121Medicaid