Provider Demographics
NPI:1538139993
Name:EAGLESON, ELIZABETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:EAGLESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:380 PLAINFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1524
Practice Address - Country:US
Practice Address - Phone:413-794-4458
Practice Address - Fax:413-794-5131
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA31750OtherBOSTON HEALTH NET
MA0036803OtherNEIGHBORHOOD HEALTH PLAN
MAEAJ29307OtherBLUE CROSS BLUE SHIELD
NY03203156Medicaid
MAA38949Medicare ID - Type UnspecifiedMEDICARE NUMBER
NY03203156Medicaid
J400011868Medicare PIN