Basic Information
| Provider Information | |||||||||
| NPI: | 1891789046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EISDORFER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14955 SHADY GROVE RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208508700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013403252 | ||||||||
| FaxNumber: | 3013401423 | ||||||||
| Practice Location | |||||||||
| Address1: | 14955 SHADY GROVE RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208508700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013403252 | ||||||||
| FaxNumber: | 3013401423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 03/04/2013 | ||||||||
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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 | 207RG0100X | D0041731 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 597761400 | 05 | MD | MEDICAID | 100005281 | 01 | MD | RAILROAD MEDICARE | OTHER |