Provider Demographics
NPI:1346613106
Name:WOMELDORF, EVAN ALEXANDER (ATC)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:ALEXANDER
Last Name:WOMELDORF
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 RITCHIE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21219-1223
Mailing Address - Country:US
Mailing Address - Phone:410-477-2042
Mailing Address - Fax:
Practice Address - Street 1:2 COLLEGE HL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-4303
Practice Address - Country:US
Practice Address - Phone:410-848-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00007502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer