Provider Demographics
NPI:1114060423
Name:EVANS, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
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 1:14 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1023
Mailing Address - Country:US
Mailing Address - Phone:207-564-0715
Mailing Address - Fax:207-564-0717
Practice Address - Street 1:14 WINTER ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1023
Practice Address - Country:US
Practice Address - Phone:207-564-0715
Practice Address - Fax:207-564-0717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013561208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME3128758OtherAETNA - HMO
ME180290000Medicaid
ME5504468OtherAETNA - NON-HMO
ME57-1152681OtherCIGNA AND OTHERS
MEP00018335OtherRAILROAD MEDICARE
ME060452OtherANTHEM
MEP00018335OtherRAILROAD MEDICARE
ME3128758OtherAETNA - HMO