Provider Demographics
NPI:1124133210
Name:RISEBERG, DAVID ANDREW (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:RISEBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:227 ST PAUL PLACE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2001
Mailing Address - Country:US
Mailing Address - Phone:410-783-5858
Mailing Address - Fax:410-783-5864
Practice Address - Street 1:227 ST PAUL PLACE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2001
Practice Address - Country:US
Practice Address - Phone:410-783-5858
Practice Address - Fax:410-783-5864
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD40854207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
52343402OtherCAREFIRST MD
R8440002OtherCAREFIRST DC
776075OtherAETNA
E96644Medicare UPIN
52343402OtherCAREFIRST MD