Provider Demographics
NPI:1114093978
Name:CONCORD RIVER MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:CONCORD RIVER MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAZNEEN
Authorized Official - Middle Name:KEYAMANESH
Authorized Official - Last Name:EISNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-663-3410
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5709
Mailing Address - Country:US
Mailing Address - Phone:978-663-3410
Mailing Address - Fax:
Practice Address - Street 1:505 MIDDLESEX TPKE UNIT 3
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3578
Practice Address - Country:US
Practice Address - Phone:978-663-3410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty