Provider Demographics
NPI:1104880491
Name:MAHAR, EVELYN (CRNA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MAHAR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:JIMINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:10810 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2138
Practice Address - Country:US
Practice Address - Phone:301-929-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704087751367500000X
MDR192332367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIEM087751OtherBLUE CROSS OF MI
MI104733240Medicaid
MIP00251897Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MIN24360300Medicare ID - Type Unspecified