Provider Demographics
NPI:1972542686
Name:EVANS, MARK PETER (LAC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PETER
Last Name:EVANS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3143
Mailing Address - Country:US
Mailing Address - Phone:603-723-6275
Mailing Address - Fax:
Practice Address - Street 1:1829 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3143
Practice Address - Country:US
Practice Address - Phone:603-723-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO772171100000X
NH096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist