Provider Demographics
NPI:1790785319
Name:EGGLESTON, JUSTIN JAMES (DO)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAMES
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:717 STATE ST
Mailing Address - Street 2:SUITE 16, LL
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:HAMOT EMERGENCY ROOM
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6139
Practice Address - Fax:814-877-6093
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS011861207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02593433OtherNY MEDICAL ASSISTANCE
PA1011365700001Medicaid
OH2484753OtherOH MEDICAL ASSISTANCE
PA410043OtherUPMC
NY00026790801OtherUNIVERA
PA7895534OtherAETNA
WV1068837OtherW. VIRGINIA WORKERS COMP
PA1537945OtherGATEWAY
PA1625163OtherBLUE SHIELD
PAP00147174OtherRR MEDICARE
PA156601OtherUNISON
PAP00147174OtherRR MEDICARE
OH2484753OtherOH MEDICAL ASSISTANCE