Individual
DR. MARK PHILIP EISENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15 FRUIT ST, MGH, FRUIT ST, MA 02114-3026
(617) 724-8135
(617) 724-8010
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-8135
(617) 724-8010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
54761
MA
207RA0401X
Addiction Medicine (Internal Medicine) Physician
54761
MA
207RI0200X
Infectious Disease Physician
54761
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054761
TUFTS HEALTH PLAN
MA
05
—
3013103
—
MA
01
—
J05654
BCBS MA
MA
Enumeration date
02/15/2006
Last updated
09/23/2022
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