Healthcare Provider Details

I. General information

NPI: 1962793786
Provider Name (Legal Business Name): MARINA A EISENBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARINA ALEKSEYEVNA BELYAYEV

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 AUBURN DR STE 100
BEACHWOOD OH
44122-4328
US

IV. Provider business mailing address

2000 AUBURN DR STE 100
BEACHWOOD OH
44122-4328
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-0120
  • Fax:
Mailing address:
  • Phone: 162-831-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301096197
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number35.126040
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: