Healthcare Provider Details

I. General information

NPI: 1053845594
Provider Name (Legal Business Name): EVELINA N PIERCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MANHATTANVILLE RD
PURCHASE NY
10577-2113
US

IV. Provider business mailing address

1162 GAINESBOROUGH DR
DALLAS GA
30157
US

V. Phone/Fax

Practice location:
  • Phone: 800-835-2362
  • Fax: 850-854-8992
Mailing address:
  • Phone: 850-240-6888
  • Fax: 850-854-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number37744
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number37744
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number92202
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: