Provider Demographics
NPI:1346567914
Name:EGEA, EDUARDO E (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:E
Last Name:EGEA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PKWY # C
Mailing Address - Street 2:STE 425
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-343-8760
Mailing Address - Fax:770-664-2101
Practice Address - Street 1:3400 OLD MILTON PKWY # C
Practice Address - Street 2:STE 425
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-343-8760
Practice Address - Fax:770-664-2101
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2021-04-26
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA071492207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I115423Medicare PIN