Provider Demographics
NPI:1083682439
Name:EVANS, LARRY ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ARTHUR
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 1:11844 ROCK LANDING DR STE B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4202
Mailing Address - Country:US
Mailing Address - Phone:757-873-0161
Mailing Address - Fax:
Practice Address - Street 1:11844 ROCK LANDING DR STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4202
Practice Address - Country:US
Practice Address - Phone:757-873-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12909207N00000X
RICMD12909207N00000X
VA0101045546207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN