MEDICARE: DR. ELIZABETH A EAGLESON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	224614	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31750	OTHER	MA	BOSTON HEALTH NET
2	0036803	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
3	EAJ29307	OTHER	MA	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538139993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH A EAGLESON M.D.

Provider Business Mailing Address
First Line	:	280 CHESTNUT ST
Second Line	:	2ND FLOOR
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1001
Country	:	US
Telephone Number	:	413-794-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 PLAINFIELD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-1524
Country	:	US
Telephone Number	:	413-794-4458
Fax Number	:	413-794-5131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/22/2017

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