Provider Demographics
NPI:1396726139
Name:EGGLIN, THOMAS K (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:K
Last Name:EGGLIN
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 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA728942085R0202X
RIMD099662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
009966OtherTUFTS
1600025OtherUNITED HEALTH PLANS
003112993OtherCT MED ASSISTANCE
007006723OtherHOSPITALPIN
3065430OtherMASSMEDICAID
720078801OtherCIGNA
30091293OtherRAILROAD MEDICARE
404203OtherBLUECHIP
000000001988OtherNHPRI
3065430OtherHEALTHYSTART
009966OtherBLUESHIELD
7006722OtherRIMEDICAL ASSISTANCE
241364OtherRIHPILGRIM