Provider Demographics
NPI:1164428744
Name:DEGLIN, EDWARD ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALAN
Last Name:DEGLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 HOLME AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-335-3088
Mailing Address - Fax:215-335-0315
Practice Address - Street 1:2701 HOLME AVE STE 303
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-335-3088
Practice Address - Fax:215-335-0315
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014247E207WX0107X
PAMD014247-E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30554OtherHEALTH PARTNERS
PA3972OtherAETNA
PA0045476000OtherKEYSTONE HEALTH PLAN EAST
PA0072440301OtherAMERICHOICE
PA072440300Medicaid
PA11326OtherHEALTH PARTNERS
PA30553OtherHEALTH PARTNERS
PA31230OtherKEYSTONE MERCY
PA149829OtherIBC
PA149829Medicare PIN
PA31230OtherKEYSTONE MERCY