Provider Demographics
NPI:1386914513
Name:LOH, EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:LOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 BROOKWAY RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1513
Mailing Address - Country:US
Mailing Address - Phone:610-667-4561
Mailing Address - Fax:610-667-4561
Practice Address - Street 1:423 BROOKWAY RD
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1513
Practice Address - Country:US
Practice Address - Phone:610-667-4561
Practice Address - Fax:610-667-4561
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052062L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE7977Medicare UPIN