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General NPI Number Information
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NPI Number | 1184208969
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Entity Type | Individual
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Provider Name | WILLIAM JOSEPH EISENHART
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Gender | Male
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Dates
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Enumeration Date | 05/08/2021
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 2120 L ST NW
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City | WASHINGTON
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State | DC
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Zip | 20037-1527
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Country | US
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Telephone | 202-669-4280
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Fax |
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Provider Business Mailing Address
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Address Line | 3703 RIVERWOOD CT
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City | ALEXANDRIA
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State | VA
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Zip | 22309-2719
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Country | US
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Telephone | 202-669-4280
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2400001200
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License Number State | DC
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