Healthcare Provider Details

I. General information

NPI: 1649254889
Provider Name (Legal Business Name): DAVID B EVANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 WALNUT BOTTOM RD STE 302
CARLISLE PA
17013-3632
US

IV. Provider business mailing address

850 WALNUT BOTTOM RD STE 302
CARLISLE PA
17013-3632
US

V. Phone/Fax

Practice location:
  • Phone: 717-258-5150
  • Fax: 717-258-3392
Mailing address:
  • Phone: 717-258-5150
  • Fax: 717-258-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD009996E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01388901
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS
# 2
Identifier0006564200001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier018603
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGMARK BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: