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Individual
DR. STACI R EISENBERG
Active
Individual
DR. STACI R EISENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
220587
MA
207R00000X
Internal Medicine Physician
MD15098
RI
208000000X
Pediatrics Physician
MD15098
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD15098
LICENSE
RI
Enumeration date
10/26/2005
Last updated
02/07/2019
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