Healthcare Provider Details

I. General information

NPI: 1659206456
Provider Name (Legal Business Name): EVAN PERKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2368652
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2368652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: