Provider Demographics
NPI:1417064718
Name:EVANS, STEVEN RAY (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RAY
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13875 HEDGEWOOD DR STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5922
Mailing Address - Country:US
Mailing Address - Phone:703-434-3633
Mailing Address - Fax:540-930-0680
Practice Address - Street 1:2617 SHEFFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-953-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417064718Medicaid
VAP00455781OtherMEDICARE RAILROAD
1072845OtherPA CERTIFICATION
VA015311L84Medicare PIN
Q73716Medicare UPIN
VA1417064718Medicaid
VA019821D08Medicare PIN