Healthcare Provider Details

I. General information

NPI: 1023073749
Provider Name (Legal Business Name): DAVID W EISELE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST JHOC 6215
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

601 N CAROLINE ST JHOC 6215
BALTIMORE MD
21287-0006
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-1080
  • Fax:
Mailing address:
  • Phone: 410-955-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD36497
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: