Provider Demographics
NPI:1851365225
Name:EGGLESTON, MAURICE KIETH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:KIETH
Last Name:EGGLESTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TOWERING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-8732
Mailing Address - Country:US
Mailing Address - Phone:540-735-4341
Mailing Address - Fax:
Practice Address - Street 1:1300 HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8451
Practice Address - Country:US
Practice Address - Phone:540-741-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031234207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherFIRST HEALTH
VAPAROtherMULTI PLAN
NC89066A1Medicaid
VA187156OtherANTHEM BC/BK VA/HK
VAPAROtherCORVEL CORCARE
VAPAROtherUSA MANAGE D CARE
VAPAROtherMID-ATLANTIC VICARE
VA006217265Medicaid
VAPAROtherVA PREMIER VPH
VA001163E79Medicare ID - Type UnspecifiedVA MEDICARE
NC89066A1Medicaid