Provider Demographics
NPI:1194357863
Name:MCEWEN, EVA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:MCEWEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:MARIE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 ENTERPRISE PKWY STE 900
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6250
Mailing Address - Country:US
Mailing Address - Phone:757-827-2480
Mailing Address - Fax:757-299-9917
Practice Address - Street 1:901 ENTERPRISE PKWY STE 900
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6250
Practice Address - Country:US
Practice Address - Phone:757-827-2480
Practice Address - Fax:757-299-9917
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant