MEDICARE: TRACEY L EVANS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	MD419780	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033152319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY L EVANS MD

Provider Business Mailing Address
First Line	:	101 E OLNEY AVE STE 400
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2470
Country	:	US
Telephone Number	:	215-456-1825
Fax Number	:	610-645-4456

Provider Business Practice Location Address
First Line	:	609 W GERMANTOWN PIKE BLDG SUITE280
Second Line	:
City	:	EAST NORRITON
State	:	PA
Zip	:	19403-4243
Country	:	US
Telephone Number	:	484-622-7440
Fax Number	:	484-622-7455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	09/21/2024

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Directions to “ TRACEY L EVANS MD” Practice Location

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