Provider Demographics
NPI:1679584569
Name:EISENFELD, MICHAEL ALAN (PAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:EISENFELD
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-662-0306
Mailing Address - Fax:855-264-2066
Practice Address - Street 1:1880 AMHERST STREET
Practice Address - Street 2:SUITE 100 AND SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-662-0306
Practice Address - Fax:855-264-2066
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01340363AM0700X
VA0110-840765363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970008085OtherRAIL ROAD MEDICARE
UT970000237Medicare ID - Type Unspecified
970008085OtherRAIL ROAD MEDICARE
S67171Medicare UPIN