MEDICARE: DR. CAROLE L EISEN MD

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	207R00000X	Internal Medicine Physician	ME017193E	PA

General Provider Information

NPI Number	:	1982058178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLE L EISEN MD

Provider Business Mailing Address
First Line	:	ONE MEDICAL CENTER BLVD., CARE MANAGEMENT DEPT.
Second Line	:	CROZER CHESTER MEDICAL CENTER
City	:	UPLAND
State	:	PA
Zip	:	19013-3995
Country	:	US
Telephone Number	:	610-447-2618
Fax Number	:	610-447-6028

Provider Business Practice Location Address
First Line	:	ONE MEDICAL CENTER BLVD., CARE MANAGEMENT DEPT.
Second Line	:	CROZER CHESTER MEDICAL CENTER
City	:	UPLAND
State	:	PA
Zip	:	19013-3995
Country	:	US
Telephone Number	:	610-447-2618
Fax Number	:	610-447-6028

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

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	04/14/2016

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