Basic Information
| Provider Information | |||||||||
| NPI: | 1235108580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGGENA | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 GLEN COVE DR | ||||||||
| Address2: | STE 202 | ||||||||
| City: | ROCKPORT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075935800 | ||||||||
| FaxNumber: | 2075935332 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 GLEN COVE DR | ||||||||
| Address2: | STE 202 | ||||||||
| City: | ROCKPORT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075935800 | ||||||||
| FaxNumber: | 2075935332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 05/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 016822 | ME | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 016822 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.