Provider Demographics
NPI:1326527417
Name:TASIOS, EVAN THOMAS (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:THOMAS
Last Name:TASIOS
Suffix:
Gender:M
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 SMITH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3652
Mailing Address - Country:US
Mailing Address - Phone:336-312-1764
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST, HALSTED BUILDING STE 600
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-502-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant