Healthcare Provider Details

I. General information

NPI: 1699955716
Provider Name (Legal Business Name): MEREDITH L. EVANS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH EVANS HERING PA-C

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S HANOVER ST
BALTIMORE MD
21225-1233
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 717-663-2000
  • Fax:
Mailing address:
  • Phone: 856-686-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: