MEDICARE: DAVID A EAGLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	200000208	NC
2	207RH0003X	Hematology & Oncology Physician	312864	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10907	OTHER		BCBS

General Provider Information

NPI Number	:	1134124910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A EAGLE M.D.

Provider Business Mailing Address
First Line	:	1 RESEARCH RD
Second Line	:
City	:	RIDGE
State	:	NY
Zip	:	11961-2701
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 E MAIN ST
Second Line	:
City	:	PATCHOGUE
State	:	NY
Zip	:	11772-3145
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/20/2024

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