Healthcare Provider Details

I. General information

NPI: 1740546126
Provider Name (Legal Business Name): EVAN SAVAGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE
PORTLAND ME
04102-2363
US

IV. Provider business mailing address

136 LINDEN DR STE 104
WINCHESTER VA
22601-6900
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-8425
  • Fax: 207-662-8443
Mailing address:
  • Phone: 540-678-3588
  • Fax: 540-678-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD21050
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: