Provider Demographics
NPI:1023008125
Name:DEGIORGIO, EUGENE R (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:R
Last Name:DEGIORGIO
Suffix:
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:PO BOX M
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-0510
Mailing Address - Country:US
Mailing Address - Phone:866-286-5888
Mailing Address - Fax:
Practice Address - Street 1:1000 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7034
Practice Address - Country:US
Practice Address - Phone:606-833-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2020-10-12
Deactivation Date:2020-08-24
Deactivation Code:
Reactivation Date:2020-10-12
Provider Licenses
StateLicense IDTaxonomies
KY279762085R0202X
OH350628972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0839981Medicaid
WV0118690000Medicaid
KY000000062617OtherBCBS
OH300111568OtherRAILROAD MEDICARE
KYP00265894OtherRAILROAD MEDICARE
KY64279763Medicaid
KYP00265894OtherRAILROAD MEDICARE
OH4017331Medicare ID - Type Unspecified