Provider Demographics
NPI:1326058132
Name:DR. GEORGE H. EVANCHO, P.C.
Entity Type:Organization
Organization Name:DR. GEORGE H. EVANCHO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:EVANCHO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-547-0123
Mailing Address - Street 1:632 CEDAR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8376
Mailing Address - Country:US
Mailing Address - Phone:757-547-0123
Mailing Address - Fax:757-547-2412
Practice Address - Street 1:632 CEDAR RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8376
Practice Address - Country:US
Practice Address - Phone:757-547-0123
Practice Address - Fax:757-547-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA- 0103000375213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA480017876OtherMEDICARE RAILROAD
VA211329OtherMAMSI
VA358171OtherANTHEM
VA52487OtherOPTIMA
VA480017876OtherMEDICARE RAILROAD
VA480949858Medicare PIN