Provider Demographics
NPI:1619912466
Name:DEUNE, EAGEN GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:EAGEN
Middle Name:GENE
Last Name:DEUNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EAGEN
Other - Middle Name:GENE
Other - Last Name:DEUNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 ALBANY ST FL G
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY ST # 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3549
Practice Address - Country:US
Practice Address - Phone:617-638-5633
Practice Address - Fax:617-414-5226
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53982207XS0106X, 208200000X, 2082S0105X
NC2019-02109208200000X, 2082S0105X
MA287912208200000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD435100200Medicaid
MDKR75132XMedicare PIN
MDKR59S640Medicare PIN
MD435100200Medicaid