Healthcare Provider Details

I. General information

NPI: 1902817117
Provider Name (Legal Business Name): DR. GEORGE H. EVANCHO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 CEDAR RD SUITE B
CHESAPEAKE VA
23322-8376
US

IV. Provider business mailing address

632 CEDAR RD SUITE B
CHESAPEAKE VA
23322-8376
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0123
  • Fax: 757-547-2412
Mailing address:
  • Phone: 757-547-0123
  • Fax: 757-547-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number179
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0103000375
License Number StateVA

VIII. Authorized Official

Name: DR. GEORGE H. EVANCHO
Title or Position: OWNER
Credential: D.P.M.
Phone: 757-547-0123