Healthcare Provider Details

I. General information

NPI: 1932190493
Provider Name (Legal Business Name): THOMAS S EAGAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 COUNTY HIGHWAY 128
GLOVERSVILLE NY
12078-4806
US

IV. Provider business mailing address

215 COUNTY HIGHWAY 128
GLOVERSVILLE NY
12078-4806
US

V. Phone/Fax

Practice location:
  • Phone: 518-773-7306
  • Fax: 518-773-8511
Mailing address:
  • Phone: 518-773-7306
  • Fax: 518-773-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1162791
License Number StateNY

VIII. Authorized Official

Name: MRS. DEBORAH A EAGAN
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 518-773-7306