Healthcare Provider Details

I. General information

NPI: 1134103237
Provider Name (Legal Business Name): PETER MCEVOY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 16TH ST NW
WASHINGTON DC
20306-0003
US

IV. Provider business mailing address

2936 CORTLAND PL NW
WASHINGTON DC
20008-3429
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-1827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number0101239005
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101239005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: