Provider Demographics
NPI:1073543047
Name:EVANS, DONALD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:THOMAS
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 1:115 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1563
Mailing Address - Country:US
Mailing Address - Phone:203-426-5626
Mailing Address - Fax:
Practice Address - Street 1:115 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1563
Practice Address - Country:US
Practice Address - Phone:203-426-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD76953Medicare UPIN