Provider Demographics
NPI:1063474625
Name:EVANKOVICH-EDWARDS, CHRISTINE (M D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:EVANKOVICH-EDWARDS
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 GORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3181
Mailing Address - Country:US
Mailing Address - Phone:304-637-9302
Mailing Address - Fax:304-637-9306
Practice Address - Street 1:812 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3181
Practice Address - Country:US
Practice Address - Phone:304-637-9302
Practice Address - Fax:304-637-9306
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810017675Medicaid
F91459Medicare UPIN
WV3810017675Medicaid
WVWV3705AMedicare PIN