Provider Demographics
NPI:1326121427
Name:PARTRIDGE, EVELYN (DO)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:PARTRIDGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3325
Mailing Address - Country:US
Mailing Address - Phone:215-744-3737
Mailing Address - Fax:215-744-1897
Practice Address - Street 1:1717 MEADOW ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3325
Practice Address - Country:US
Practice Address - Phone:215-744-3737
Practice Address - Fax:215-744-1897
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004452L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00515281OtherUNITED HEALTH
PA0857651Medicaid
PA00479OtherHEALTH PARTNERS
PA1527OtherELDER HEALTH
PA06579OtherKEYSTONE EAST
PA100152OtherKEYSTONE MERCY
PA4101782OtherAETNA
PA008576501OtherAMERICHOICE
PAC28745Medicare UPIN
PA00479OtherHEALTH PARTNERS