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General NPI Number Information
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NPI Number | 1902817117
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Entity Type | Organization
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Legal Business Name | DR. GEORGE H. EVANCHO, P.C.
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 632 CEDAR RD SUITE B
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City | CHESAPEAKE
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State | VA
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Zip | 23322-8376
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Country | US
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Telephone | 757-547-0123
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Fax | 757-547-2412
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Provider Business Mailing Address
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Address Line | 632 CEDAR RD SUITE B
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City | CHESAPEAKE
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State | VA
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Zip | 23322-8376
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Country | US
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Telephone | 757-547-0123
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Fax | 757-547-2412
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE H. EVANCHO
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Credential | D.P.M.
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Telephone | 757-547-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 179
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0103000375
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License Number State | VA
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