Provider Demographics
NPI:1285612374
Name:EVIVIE, PATRICK E (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:E
Last Name:EVIVIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3627 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3249
Mailing Address - Country:US
Mailing Address - Phone:704-335-0806
Mailing Address - Fax:704-334-2073
Practice Address - Street 1:3627 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3249
Practice Address - Country:US
Practice Address - Phone:704-335-0806
Practice Address - Fax:704-334-2073
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890271WMedicaid
NC890271WMedicaid
NC2321578Medicare ID - Type Unspecified
NCG45438Medicare UPIN