Provider Demographics
NPI:1386617967
Name:NORTHEAST PENNSYLVANIA NEPHROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:NORTHEAST PENNSYLVANIA NEPHROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:W
Authorized Official - Last Name:EAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-348-0360
Mailing Address - Street 1:802 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1038
Mailing Address - Country:US
Mailing Address - Phone:570-348-0360
Mailing Address - Fax:570-348-0362
Practice Address - Street 1:802 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1038
Practice Address - Country:US
Practice Address - Phone:570-348-0360
Practice Address - Fax:570-348-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA851436OtherBLUE CROSS BLUE SHIELD