Healthcare Provider Details

I. General information

NPI: 1932146115
Provider Name (Legal Business Name): MARK RAYMOND EVANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 S EDGERTON RD STE 500
BRECKSVILLE OH
44141-4206
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-4543
  • Fax: 440-526-6126
Mailing address:
  • Phone: 440-526-4543
  • Fax: 440-526-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35072737
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: