Provider Demographics
NPI:1407921687
Name:CWASS, EVAN P (DPM)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:P
Last Name:CWASS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 N MAIN ST
Mailing Address - Street 2:SUITE #11
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1815
Mailing Address - Country:US
Mailing Address - Phone:413-525-4373
Mailing Address - Fax:413-525-9098
Practice Address - Street 1:264 N MAIN ST
Practice Address - Street 2:SUITE #11
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1815
Practice Address - Country:US
Practice Address - Phone:413-525-4373
Practice Address - Fax:413-525-9098
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2038213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU39805Medicare UPIN
Y75008Medicare PIN