Healthcare Provider Details

I. General information

NPI: 1740575786
Provider Name (Legal Business Name): IDRIS EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE ONE CHILDREN'S HOSPITAL DRIVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

4401 PENN AVE ONE CHILDREN'S HOSPITAL DRIVE
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT199564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: