Provider Demographics
NPI:1194893982
Name:EISENHARDT, ELIZABETH B (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:EISENHARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-781-1500
Practice Address - Fax:207-781-1507
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD18198207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434423399Medicaid
MEP01213780Medicare PIN
ME001188603Medicare PIN
MEP00772763Medicare PIN
ME434423399Medicaid
NH30208843Medicare PIN
ME001188604Medicare PIN
ME001188601Medicare PIN
ME001188602Medicare PIN