Provider Demographics
NPI:1992116610
Name:EGLITIS, AUTUMN DAWN (MD)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:DAWN
Last Name:EGLITIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:DAWN
Other - Last Name:METZGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1875 S GRANT ST STE 760
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2670
Mailing Address - Country:US
Mailing Address - Phone:888-227-8884
Mailing Address - Fax:
Practice Address - Street 1:1875 S GRANT ST STE 760
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2670
Practice Address - Country:US
Practice Address - Phone:888-227-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276876207Q00000X
ORMD192399207Q00000X
CAA150389207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine