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General NPI Number Information
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NPI Number | 1346219029
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Entity Type | Individual
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Provider Name | MARY PALMQUIST EVANS M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 210 ELM AVE
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City | LOUISA
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State | VA
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Zip | 23093-6578
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Country | US
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Telephone | 434-242-7077
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6126
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-6126
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Country | US
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Telephone | 434-242-7077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101233405
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License Number State | VA
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