Provider Demographics
NPI:1386794147
Name:E Y EVANS MD LLC
Entity type:Organization
Organization Name:E Y EVANS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-243-3352
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-0323
Mailing Address - Country:US
Mailing Address - Phone:860-243-3352
Mailing Address - Fax:860-243-3329
Practice Address - Street 1:701 COTTAGE GROVE RD
Practice Address - Street 2:BUILDING C SUITE 130
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-0323
Practice Address - Country:US
Practice Address - Phone:860-243-3352
Practice Address - Fax:860-243-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03923Medicare PIN