Provider Demographics
NPI:1235108580
Name:EGGENA, MARK PETER (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PETER
Last Name:EGGENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856
Mailing Address - Country:US
Mailing Address - Phone:207-593-5800
Mailing Address - Fax:207-593-5332
Practice Address - Street 1:4 GLEN COVE DR
Practice Address - Street 2:STE 202
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856
Practice Address - Country:US
Practice Address - Phone:207-593-5800
Practice Address - Fax:207-593-5332
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016822207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I34220Medicare UPIN
ME1409Medicare ID - Type Unspecified