Provider Demographics
NPI:1326071374
Name:EVALDI, MARTIN F (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:F
Last Name:EVALDI
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:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0198
Mailing Address - Country:US
Mailing Address - Phone:316-685-6091
Mailing Address - Fax:
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6019
Practice Address - Country:US
Practice Address - Phone:843-664-3301
Practice Address - Fax:843-664-3723
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9317207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC093179Medicaid
SC050084922Medicare PIN
B92364Medicare UPIN
SCB923647234Medicare PIN