Provider Demographics
NPI:1295742773
Name:EISENBERG, EDWARD FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FRANKLIN
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:AUGUSTA HEALTH
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-332-4326
Practice Address - Fax:540-332-4339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045222207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5747236Medicaid
VA5747236Medicaid
E45552Medicare UPIN