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General NPI Number Information
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NPI Number | 1053472175
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Entity Type | Individual
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Provider Name | RICHARD H. EISENMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 2376 CYPRESS CIRCLE SUITE 203
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City | CONWAY
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State | SC
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Zip | 29526-8994
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Country | US
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Telephone | 843-347-6038
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Fax | 843-347-9808
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Provider Business Mailing Address
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Address Line | PO BOX 2180
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City | CONWAY
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State | SC
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Zip | 29528-2180
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Country | US
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Telephone | 843-347-6038
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Fax | 843-234-6990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 14836
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License Number State | SC
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