1396726139 NPI number — THOMAS K EGGLIN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396726139 NPI number — THOMAS K EGGLIN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

EGGLIN

Provider First Name:

THOMAS

Provider Middle Name:

K

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1396726139

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/21/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

125 METRO CENTER BLVD STE 2000

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WARWICK

Provider Business Mailing Address State Name:

RI

Provider Business Mailing Address Postal Code:

02886-1785

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

401-432-2520

Provider Business Mailing Address Fax Number:

401-453-8220

Provider First Line Business Practice Location Address:

125 METRO CENTER BLVD STE 2000

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WARWICK

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02886-1785

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-432-2520

Provider Business Practice Location Address Fax Number:

401-453-8220

Provider Enumeration Date:

11/09/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  72894 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: MD09966 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 009966 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1600025 . This is a "UNITED HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
• Identifier: 003112993 . This is a "CT MED ASSISTANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 007006723 . This is a "HOSPITALPIN" identifier . This identifiers is of the category "OTHER".
• Identifier: 3065430 . This is a "MASSMEDICAID" identifier . This identifiers is of the category "OTHER".
• Identifier: 720078801 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 30091293 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 404203 . This is a "BLUECHIP" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000001988 . This is a "NHPRI" identifier . This identifiers is of the category "OTHER".
• Identifier: 3065430 . This is a "HEALTHYSTART" identifier . This identifiers is of the category "OTHER".
• Identifier: 009966 . This is a "BLUESHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 7006722 . This is a "RIMEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 241364 . This is a "RIHPILGRIM" identifier . This identifiers is of the category "OTHER".