Provider Demographics
NPI:1114367372
Name:EVANS, MARA S (MS, MED)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:S
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GULLY LN
Mailing Address - Street 2:
Mailing Address - City:E SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1304
Mailing Address - Country:US
Mailing Address - Phone:508-888-6217
Mailing Address - Fax:
Practice Address - Street 1:14 GULLY LN
Practice Address - Street 2:
Practice Address - City:E SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1304
Practice Address - Country:US
Practice Address - Phone:508-888-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist