Provider Demographics
NPI:1912936691
Name:EAGLE, RALPH C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:C
Last Name:EAGLE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:840 WALNUT STREET
Mailing Address - Street 2:SUITE 1230
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-440-3160
Mailing Address - Fax:215-928-3465
Practice Address - Street 1:840 WALNUT STREET
Practice Address - Street 2:SUITE 1230
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-928-3041
Practice Address - Fax:215-928-3225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2015-06-01
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Provider Licenses
StateLicense IDTaxonomies
PAMD012750E207W00000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004908Medicare PIN
B95868Medicare UPIN