Healthcare Provider Details

I. General information

NPI: 1124185236
Provider Name (Legal Business Name): MICHELE KIM EVANS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 NATHAN SHOCK DR MAILBOX 09 NATIONAL INSTITUTE ON AGING
BALTIMORE MD
21224-6825
US

IV. Provider business mailing address

5600 NATHAN SHOCK DRIVE MAILBOX 09 NATIONAL INSTITUTE ON AGING
BALTIMORE MD
21224-6825
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-8573
  • Fax: 410-558-8268
Mailing address:
  • Phone: 410-558-8573
  • Fax: 410-558-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD0033887
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: