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General NPI Number Information
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NPI Number | 1790785319
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Entity Type | Individual
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Provider Name | JUSTIN JAMES EGGLESTON DO
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Gender | Male
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 201 STATE ST HAMOT EMERGENCY ROOM
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City | ERIE
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State | PA
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Zip | 16550-0002
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Country | US
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Telephone | 814-877-6139
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Fax | 814-877-6093
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Provider Business Mailing Address
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Address Line | 717 STATE ST SUITE 16, LL
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City | ERIE
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State | PA
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Zip | 16501-1341
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Country | US
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Telephone | 814-480-7100
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Fax | 814-480-7604
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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 | OS011861
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License Number State | PA
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