# MARK J. EISEN, M.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255447967
- **Authorized official:** MR. MARCUS W GILLIKIN MD, MBA (CONSULTANT)
- **Authorized official phone:** (252) 353-7162

## Contact information

- **Practice address:** 900 MARTIN LUTHER KING JR BLVD, SUTIE A, CHAPEL HILL, NC 27514-2601
- **Practice address phone:** (919) 967-3452
- **Practice address fax:** (919) 932-5200
- **Mailing address:** PO BOX 30696, GREENVILLE, NC 27833-0696
- **Mailing address phone:** (252) 353-7162
- **Mailing address fax:** (252) 353-1760

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 25580 | NC | Yes |

## Other

- **Enumeration date:** 08/23/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8930263 | — | NC |