Individual
JAMES CONRAD EISENACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
29912
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
29912
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30259
BCBS
—
05
—
3810001302
—
WV
01
—
402
PARTNERS
—
01
—
4098394
AETNA
—
05
—
5728495
—
VA
01
—
63954
MEDCOST
—
05
—
8930273
—
NC
05
—
Q29912
—
SC
Enumeration date
12/13/2005
Last updated
08/30/2017
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