Provider Demographics
NPI:1689651267
Name:EGAN, AUSTIN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:PATRICK
Last Name:EGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 CARLETON ST
Mailing Address - Street 2:MIT MEDICAL
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1323
Mailing Address - Country:US
Mailing Address - Phone:617-253-0811
Mailing Address - Fax:617-258-0428
Practice Address - Street 1:25 CARLETON ST
Practice Address - Street 2:MIT MEDICAL
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1323
Practice Address - Country:US
Practice Address - Phone:617-253-0811
Practice Address - Fax:617-258-0428
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2016-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA79037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF27810Medicare UPIN
J30816Medicare ID - Type Unspecified