Active NPI
Dan Elijah Eisenberg
- Dentist
- Olney, MD
National Provider Identifier
1871736181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13260
- Practice address
- 18111 Prince Philip Dr
T-17
Olney, MD 20832-1513 - Phone
- (301) 774-7887
- Fax
- (301) 774-9221
- NPI assigned
- Apr 16, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13260 | MD | Primary |
Addresses
Primary practice location
18111 Prince Philip Dr
T-17
Olney, MD 20832-1513
Mailing address
18111 Prince Philip Dr
T-17
Olney, MD 20832-1513
Phone (301) 774-7887
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13260 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281052800000",
"number": "1871736181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18111 PRINCE PHILIP DR",
"address_2": "T-17",
"city": "OLNEY",
"state": "MD",
"postal_code": "208321513",
"telephone_number": "301-774-7887",
"fax_number": "301-774-9221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18111 PRINCE PHILIP DR",
"address_2": "T-17",
"city": "OLNEY",
"state": "MD",
"postal_code": "208321513",
"telephone_number": "301-774-7887",
"fax_number": "301-774-9221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EISENBERG",
"first_name": "DAN",
"middle_name": "ELIJAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-16",
"last_updated": "2010-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "13260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olney, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.