Basic Information
| Provider Information | |||||||||
| NPI: | 1134226020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EISENBERG | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | JUDITH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 WOODLAND RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | SAINT HELENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945749562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079637200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6 WOODLAND RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | SAINT HELENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945749562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079637200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | G065056 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 036290 | 01 | CA | HILL PHYSICIANS PROVIDER | OTHER | G65056 | 05 | CA | MEDICAID | P01474554 | 01 | CA | RAILROAD MEDICARE (JMH) | OTHER | GR0098120 | 05 | CA | MEDICAID | DB0077 | 01 | CA | MC RAIL ROAD GROUP NUMBER | OTHER |