Provider Demographics
NPI:1306936620
Name:RUNER, EVELYN ROSARIO (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ROSARIO
Last Name:RUNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4634 HILLS AND DALES RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1510
Mailing Address - Country:US
Mailing Address - Phone:267-594-4352
Mailing Address - Fax:267-594-4362
Practice Address - Street 1:333 N. OXFORD VALLEY RD.
Practice Address - Street 2:SUITE 404
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-741-4016
Practice Address - Fax:215-741-4019
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD064046L207RE0101X
PAMD064046-L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHO2737Medicare UPIN
HO2737Medicare UPIN