Basic Information
| Provider Information | |||||||||
| NPI: | 1912964263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EBERHART | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 LAFAYETTE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038015679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034319147 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 LAFAYETTE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038015679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034319147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 02/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 7386 | NH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 012297 | ME | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 47787 | MA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 80008516 | 05 | NH | MEDICAID |