MEDICARE: EMILY CAROLYN EVANS PA-C

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	363AM0700X	Medical Physician Assistant	MA067523	PA

General Provider Information

NPI Number	:	1477177806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY CAROLYN EVANS PA-C

Provider Business Mailing Address
First Line	:	230 N 21ST ST UNIT 313
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 N 21ST ST UNIT 313
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1143
Country	:	US
Telephone Number	:	714-421-9145
Fax Number	:

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

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	01/17/2026

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