Healthcare Provider Details

I. General information

NPI: 1346078524
Provider Name (Legal Business Name): EVANS YE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

83 MEADOW AVE
STATEN ISLAND NY
10304-3203
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-1251
  • Fax:
Mailing address:
  • Phone: 907-972-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: