Provider Demographics
NPI:1598313959
Name:EAGLE MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:EAGLE MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLAI
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZDRALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-610-1743
Mailing Address - Street 1:PO BOX 14397
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-7397
Mailing Address - Country:US
Mailing Address - Phone:330-758-2775
Mailing Address - Fax:330-758-2787
Practice Address - Street 1:1637 ROYAL OAK DR
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8656
Practice Address - Country:US
Practice Address - Phone:412-610-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty