Provider Demographics
NPI:1871567263
Name:EGAN, RITA M (MD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:M
Last Name:EGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9798
Mailing Address - Country:US
Mailing Address - Phone:720-771-4015
Mailing Address - Fax:
Practice Address - Street 1:3260 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9798
Practice Address - Country:US
Practice Address - Phone:720-771-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24896207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64248966Medicaid
KY3937OtherMEDICARE GROUP NUMBER
KY64248966Medicaid
KY3937OtherMEDICARE GROUP NUMBER