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General NPI Number Information
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NPI Number | 1932190493
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Entity Type | Organization
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Legal Business Name | THOMAS S EAGAN MD PC
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 215 COUNTY HIGHWAY 128
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-4806
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Country | US
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Telephone | 518-773-7306
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Fax | 518-773-8511
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Provider Business Mailing Address
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Address Line | 215 COUNTY HIGHWAY 128
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-4806
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Country | US
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Telephone | 518-773-7306
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Fax | 518-773-8511
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBORAH A EAGAN
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Credential | RN
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Telephone | 518-773-7306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 1162791
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License Number State | NY
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