Provider Demographics
NPI:1265415533
Name:EAGLE, JANINE R (MD)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:R
Last Name:EAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:OPHTHALMOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-5123
Mailing Address - Fax:603-676-4090
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:OPHTHALMOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-5123
Practice Address - Fax:603-676-4090
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH13766207W00000X
MA160082207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110061703AMedicaid
NH3084523Medicaid
NH3084523Medicaid
NH527201Medicare PIN