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General NPI Number Information
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NPI Number | 1649156035
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Entity Type | Individual
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Provider Name | EVAN PRUSISZ
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Gender | Male
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 16301 ELLIOTT PKWY, WILLIAMSPORT, MD 21795
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City | WILLIAMSPORT
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State | MD
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Zip | 21795
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Country | US
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Telephone | 240-313-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 468 HAYSTACK DR
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City | NEWARK
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State | DE
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Zip | 19711
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Country | US
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Telephone | 302-518-0626
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | MD
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