MEDICARE: DR. MARINA A EISENBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	4301096197	MI
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician	35.126040	OH

General Provider Information

NPI Number	:	1962793786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARINA A EISENBERG M.D.

Provider Business Mailing Address
First Line	:	2000 AUBURN DR STE 100
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4328
Country	:	US
Telephone Number	:	162-831-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 AUBURN DR STE 100
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4328
Country	:	US
Telephone Number	:	216-831-0120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	12/08/2022

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