Provider Demographics
NPI:1508101643
Name:MAYFIELD, EVAN DAVID (MHS, MS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:DAVID
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:MHS, MS, PA-C
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Mailing Address - Street 1:5401 OLD COURT RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5103
Mailing Address - Country:US
Mailing Address - Phone:410-521-5973
Mailing Address - Fax:410-521-7669
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-9080
Practice Address - Fax:336-718-9085
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2022-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03661363A00000X, 363AS0400X
MDC05396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical