Healthcare Provider Details

I. General information

NPI: 1265468110
Provider Name (Legal Business Name): ANDREW M EVENS DO, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON STREET TUFTS MEDICAL CENTER
BOSTON MA
02111
US

IV. Provider business mailing address

800 WASHINGTON STREET TUFTS MEDICAL CENTER
BOSTON MA
02111
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-8077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number036-098507
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number246238
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25MB10237400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25MB10237400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: