Individual
TARA RAQUEL EISENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 S 11TH ST, SUITE 3390, PHILADELPHIA, PA 19107-4824
(215) 955-6226
(215) 923-1562
Mailing address
111 S 11TH ST, SUITE 3390, PHILADELPHIA, PA 19107-4824
(215) 955-6226
(215) 923-1562
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD437294
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102337804
—
PA
01
—
145XU
BCBSNC
NC
05
—
5907571
—
NC
Enumeration date
03/20/2007
Last updated
06/10/2010
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