Provider Demographics
NPI:1104038272
Name:BLOCH, EVAN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:MARTIN
Last Name:BLOCH
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 1:3351 EL CAMINO REAL
Mailing Address - Street 2:STE 101
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3802
Mailing Address - Country:US
Mailing Address - Phone:650-306-1016
Mailing Address - Fax:650-369-3627
Practice Address - Street 1:3351 EL CAMINO REAL
Practice Address - Street 2:STE 101
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3802
Practice Address - Country:US
Practice Address - Phone:650-306-1016
Practice Address - Fax:650-369-3627
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222456174400000X
CAA101679207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist