Provider Demographics
NPI:1548478993
Name:MORTON-EGGLESTON, EMMA (MD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:MORTON-EGGLESTON
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 1:880 N TENNESSEE AVE STE 110A
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9401
Mailing Address - Country:US
Mailing Address - Phone:304-596-5038
Mailing Address - Fax:304-596-5037
Practice Address - Street 1:880 N TENNESSEE AVE STE 110A
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9401
Practice Address - Country:US
Practice Address - Phone:304-596-5038
Practice Address - Fax:304-596-5037
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242403207RE0101X
VA0116016751390200000X
WV27240207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program