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General NPI Number Information
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NPI Number | 1730610346
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Entity Type | Individual
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Provider Name | EVAN ANDREW PLUNKETT MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 3009 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1214
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Country | US
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Telephone | 919-232-5020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 603949
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City | CHARLOTTE
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State | NC
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Zip | 28260-3949
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Country | US
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Telephone | 919-350-2266
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Fax | 919-350-7687
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2024-00197
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301507944
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 4301507944
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 2024-00197
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License Number State | NC
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