Provider Demographics
NPI:1992818421
Name:EVANS, THOMAS K (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:EVANS
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 1:1 CENTURIAN DR STE 307
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2127
Mailing Address - Country:US
Mailing Address - Phone:302-543-8100
Mailing Address - Fax:302-543-8905
Practice Address - Street 1:1 CENTURIAN DR STE 307
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-543-8100
Practice Address - Fax:302-543-8905
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00077542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000014369Medicaid
018414D21Medicare PIN
D19015Medicare UPIN