Healthcare Provider Details

I. General information

NPI: 1033164058
Provider Name (Legal Business Name): RONA B EISEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11065 LITTLE PATUXENT PKWY SUITE 200
COLUMBIA MD
21044-2998
US

IV. Provider business mailing address

11065 LITTLE PATUXENT PKWY SUITE 200
COLUMBIA MD
21044-2998
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-5700
  • Fax: 410-964-3231
Mailing address:
  • Phone: 410-730-5700
  • Fax: 410-964-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD22870
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: