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General NPI Number Information
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NPI Number | 1972542686
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Entity Type | Individual
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Provider Name | MARK PETER EVANS L.AC.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 1829 RIVERSIDE DR
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City | BERLIN
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State | NH
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Zip | 03570-3143
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Country | US
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Telephone | 603-723-6275
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Fax |
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Provider Business Mailing Address
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Address Line | 1829 RIVERSIDE DR
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City | BERLIN
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State | NH
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Zip | 03570-3143
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Country | US
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Telephone | 603-723-6275
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 772
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 096
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License Number State | NH
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