Healthcare Provider Details

I. General information

NPI: 1194087312
Provider Name (Legal Business Name): MARTIN OMAN EVANS II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 02/07/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD N
BETHESDA MD
20814
US

IV. Provider business mailing address

4494 PALMER RD N
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4511
  • Fax:
Mailing address:
  • Phone: 301-295-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102203677
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102203677
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number0102203677
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0102203677
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: