Healthcare Provider Details

I. General information

NPI: 1285850784
Provider Name (Legal Business Name): EVAN MARIASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W BROADWAY AVE
ROBBINSDALE MN
55422-2969
US

IV. Provider business mailing address

3435 W BROADWAY AVE
ROBBINSDALE MN
55422-2969
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-2801
  • Fax:
Mailing address:
  • Phone: 763-581-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD13676
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number59748
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberLP00959
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: