Provider Demographics
NPI:1386677656
Name:BRATHWAITE, EVAN ANTHONY (MD FACP)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:ANTHONY
Last Name:BRATHWAITE
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1608
Mailing Address - Country:US
Mailing Address - Phone:718-230-7046
Mailing Address - Fax:718-230-7046
Practice Address - Street 1:55 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1608
Practice Address - Country:US
Practice Address - Phone:718-230-7046
Practice Address - Fax:718-230-7046
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine