Provider Demographics
NPI:1063401263
Name:EVANS, CHRISTOPHER JOHN (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:EVANS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2632
Mailing Address - Country:US
Mailing Address - Phone:717-812-8871
Mailing Address - Fax:717-812-8624
Practice Address - Street 1:1777 5TH AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2632
Practice Address - Country:US
Practice Address - Phone:717-812-8871
Practice Address - Fax:717-812-8624
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009169L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017934790003Medicaid
PA0017934790003Medicaid
PA036324YBTMedicare PIN