Healthcare Provider Details

I. General information

NPI: 1316975097
Provider Name (Legal Business Name): CHRISTINE C EVANCHICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 MAIN ST
SPRINGFIELD MA
01104-3300
US

IV. Provider business mailing address

2150 MAIN STREET
SPRINGFIELD MA
01104
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-5676
  • Fax: 413-739-2278
Mailing address:
  • Phone: 413-739-5676
  • Fax: 413-739-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number58598
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: