Healthcare Provider Details

I. General information

NPI: 1760580872
Provider Name (Legal Business Name): ABRAHAM HARRY EISEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

4620 N PARK AVE 1505 EAST
CHEVY CHASE MD
20815-4549
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0057244
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: