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General NPI Number Information
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NPI Number | 1770523870
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Entity Type | Individual
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Provider Name | SUSANNA G. EVANS MD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 10 SHURS LN SUITE 409
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City | PHILADELPHIA
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State | PA
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Zip | 19127-2123
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Country | US
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Telephone | 215-482-1234
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Fax | 215-482-0465
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Provider Business Mailing Address
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Address Line | 1601 CHERRY ST SUITE 11511
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1321
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Country | US
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Telephone | 215-255-7822
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD417655
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License Number State | PA
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