Provider Demographics
NPI:1104323286
Name:MICHAELSON, EVAN MILLER (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:MILLER
Last Name:MICHAELSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2629 RIVA RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7428
Mailing Address - Country:US
Mailing Address - Phone:410-573-2530
Mailing Address - Fax:410-573-2536
Practice Address - Street 1:2629 RIVA RD STE 114
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7428
Practice Address - Country:US
Practice Address - Phone:410-573-2530
Practice Address - Fax:410-573-2536
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0101580207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery