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General NPI Number Information
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NPI Number | 1346216827
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Entity Type | Individual
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Provider Name | JAMES EGAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 11680 DOOLITTLE DR SUITE 111
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City | WALDORF
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State | MD
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Zip | 20602-3801
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Country | US
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Telephone | 240-607-2756
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Fax | 240-607-2776
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Provider Business Mailing Address
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Address Line | 1282 SMALLWOOD DR W SUITE 507
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City | WALDORF
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State | MD
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Zip | 20603-4732
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Country | US
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Telephone | 240-607-2756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0101042094
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License Number State | VA
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