Healthcare Provider Details

I. General information

NPI: 1003437583
Provider Name (Legal Business Name): EVAN FOX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

6565 N CHARLES ST STE 203
TOWSON MD
21204-5805
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone: 443-849-3760
  • Fax: 443-849-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberD0094413
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: