Healthcare Provider Details

I. General information

NPI: 1730126483
Provider Name (Legal Business Name): TODD D EISENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax: 503-220-3499
Mailing address:
  • Phone: 503-220-8262
  • Fax: 503-220-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD28859
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD28859
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: