MEDICARE: DR. DAVID EVANKO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD039206L	PA

General Provider Information

NPI Number	:	1871521617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID EVANKO M.D.

Provider Business Mailing Address
First Line	:	960 BULLCREEK RD
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16002-8684
Country	:	US
Telephone Number	:	724-282-3764
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 BULLCREEK RD
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16002-8684
Country	:	US
Telephone Number	:	724-282-3764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/28/2010

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