Provider Demographics
NPI:1972681674
Name:EATOUGH, PHILIP BRADLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BRADLEY
Last Name:EATOUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2510
Mailing Address - Country:US
Mailing Address - Phone:732-671-0411
Mailing Address - Fax:732-671-2118
Practice Address - Street 1:4 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2510
Practice Address - Country:US
Practice Address - Phone:732-671-0411
Practice Address - Fax:732-671-2118
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB25996207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55880Medicare UPIN