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General NPI Number Information
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NPI Number | 1780653501
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Entity Type | Individual
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Provider Name | OSVALDO JOSE EVANGELISTA MD
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Gender | Male
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 40 PLEASANT ST
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City | CONCORD
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State | NH
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Zip | 03301-4006
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Country | US
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Telephone | 603-228-1551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2032
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City | CONCORD
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State | NH
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Zip | 03302-2032
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Country | US
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Telephone |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 15749
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License Number State | NH
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