Provider Demographics
NPI:1336148121
Name:EISENBERG, MAUREEN (DO)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PENN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1929
Mailing Address - Country:US
Mailing Address - Phone:717-632-4449
Mailing Address - Fax:717-632-3553
Practice Address - Street 1:111 PENN ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1929
Practice Address - Country:US
Practice Address - Phone:717-632-4449
Practice Address - Fax:717-632-3553
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD05008158L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG05717Medicare UPIN