Provider Demographics
NPI:1104986744
Name:DAVID E. EISENBERG, M.D.
Entity type:Organization
Organization Name:DAVID E. EISENBERG, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-539-0909
Mailing Address - Street 1:42 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2920
Mailing Address - Country:US
Mailing Address - Phone:617-539-0909
Mailing Address - Fax:617-539-1700
Practice Address - Street 1:42 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2920
Practice Address - Country:US
Practice Address - Phone:617-539-0909
Practice Address - Fax:617-539-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36137207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9785116Medicaid
MA0911010001Medicare NSC
MAC04690Medicare PIN