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General NPI Number Information
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NPI Number | 1659502177
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Entity Type | Individual
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Provider Name | MATTHEW DAVID EGGLESTON D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 1044 BELMONT AVE EMERGENCY DEPARTMENT
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City | YOUNGSTOWN
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State | OH
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Zip | 44504
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Country | US
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Telephone | 330-480-3667
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Fax |
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Provider Business Mailing Address
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Address Line | 667 EASTLAND AVE SE ST JOSEPH HEALTH CENTER
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City | WARREN
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State | OH
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Zip | 44484-4503
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Country | US
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Telephone | 330-841-4784
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Fax | 330-841-4207
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 58.003559
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34.010462
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | SL0654
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License Number State | NV
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