Healthcare Provider Details

I. General information

NPI: 1891149126
Provider Name (Legal Business Name): EVAN WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2016
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

6451 N FEDERAL HWY STE 800
FORT LAUDERDALE FL
33308-1409
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6045
  • Fax: 570-271-6542
Mailing address:
  • Phone: 510-725-0028
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD-22103
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD487829
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD205832
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberTEMP
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: