Provider Demographics
NPI:1912198144
Name:EVANS, MARK GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GEORGE
Last Name:EVANS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE # 4903
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:499 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3602
Practice Address - Country:US
Practice Address - Phone:570-714-3050
Practice Address - Fax:570-714-3055
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252422207R00000X
PAOS013931207R00000X
NJ25MB08372100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine