Provider Demographics
NPI:1508812272
Name:BASH, EVAN K (MD)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:K
Last Name:BASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:ONE MEDICAL CTR BLVD
Mailing Address - Street 2:CCMC POB II STE 324
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-876-0347
Mailing Address - Fax:610-876-3788
Practice Address - Street 1:ONE MEDICAL CTR BLVD
Practice Address - Street 2:CCMC POB II STE 324
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-876-0347
Practice Address - Fax:610-876-3788
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD030656E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1115540Medicaid
C34748Medicare UPIN
PA1115540Medicaid