Provider Demographics
NPI:1487653440
Name:EVANCHO, GEORGE H (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:EVANCHO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 CEDAR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8376
Mailing Address - Country:US
Mailing Address - Phone:757-547-0123
Mailing Address - Fax:757-547-2412
Practice Address - Street 1:632 CEDAR RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8376
Practice Address - Country:US
Practice Address - Phone:757-547-0123
Practice Address - Fax:757-547-2412
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000375213E00000X
NC179213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA52487OtherOPTIMA
VA211329OtherMAMSI
VA358171OtherANTHEM
VA480017876OtherMEDICARE RAILROAD
VA211329OtherMAMSI
VAT21897Medicare UPIN