Healthcare Provider Details

I. General information

NPI: 1629373899
Provider Name (Legal Business Name): DR A EVANS-WOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 08/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17204 MCMULLEN HWY SW
CUMBERLAND MD
21502-6214
US

IV. Provider business mailing address

17204 MCMULLEN HWY SW
CUMBERLAND MD
21502-6214
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-0060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberH0056080
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLISON L EVANS-WOOD
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 301-729-0060