Provider Demographics
NPI:1518950021
Name:MAIR, EVAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:ROBERT
Last Name:MAIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:STONY BROOK RADIOLOGY UFPC
Mailing Address - Street 2:HSC LEVEL 4, ROOM 120
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8460
Mailing Address - Country:US
Mailing Address - Phone:631-444-5400
Mailing Address - Fax:631-444-7538
Practice Address - Street 1:STONY BROOK RADIOLOGY UFPC
Practice Address - Street 2:HSC LEVEL 4, ROOM 120
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8460
Practice Address - Country:US
Practice Address - Phone:631-444-5400
Practice Address - Fax:631-444-7538
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-10-23
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Provider Licenses
StateLicense IDTaxonomies
NY2313322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02675607Medicaid
NY02675607Medicaid
NYI33912Medicare UPIN