Healthcare Provider Details

I. General information

NPI: 1568656155
Provider Name (Legal Business Name): CLEOFE P EVANGELISTA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OXFORD VALLEY RD SUITE 403A
YARDLEY PA
19067-7706
US

IV. Provider business mailing address

301 OXFORD VALLEY RD SUITE 403A
YARDLEY PA
19067-7706
US

V. Phone/Fax

Practice location:
  • Phone: 215-321-0580
  • Fax: 215-321-9098
Mailing address:
  • Phone: 215-321-0580
  • Fax: 215-321-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD030470E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD034070E
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. CLEOFE P EVANGELISTA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 215-321-0580