Healthcare Provider Details

I. General information

NPI: 1861155145
Provider Name (Legal Business Name): DELANEY EISENBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66B CONCORD ST
WILMINGTON MA
01887-2194
US

IV. Provider business mailing address

21 QUARRY LN UNIT 8414
MALDEN MA
02148-5039
US

V. Phone/Fax

Practice location:
  • Phone: 978-657-3826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: