Provider Demographics
NPI:1376603365
Name:EVANS, JOEL MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARK
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1011 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1610
Mailing Address - Country:US
Mailing Address - Phone:203-321-0200
Mailing Address - Fax:203-321-0300
Practice Address - Street 1:1011 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1610
Practice Address - Country:US
Practice Address - Phone:203-321-0200
Practice Address - Fax:203-321-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029082207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98417Medicare UPIN