Provider Demographics
NPI:1467400119
Name:EKMAN, EVAN FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:FRANKLIN
Last Name:EKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:803-761-9191
Mailing Address - Fax:
Practice Address - Street 1:191 CENTRE SOUTH BLVD STE 30
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6313
Practice Address - Country:US
Practice Address - Phone:803-761-9191
Practice Address - Fax:803-873-9984
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36694207X00000X
SC19175207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC191759Medicaid
SC6713Medicare PIN
SCG35936Medicare UPIN
SC191759Medicaid