Healthcare Provider Details

I. General information

NPI: 1184751760
Provider Name (Legal Business Name): DRS. EISENGART, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325C KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4517
US

IV. Provider business mailing address

325C KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4517
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-1990
  • Fax: 207-877-6639
Mailing address:
  • Phone: 207-873-1990
  • Fax: 207-877-6639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number007664
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number007665
License Number StateME

VIII. Authorized Official

Name: MARVIN A EISENGART
Title or Position: PRESIDENT
Credential: MD
Phone: 207-873-1990