Provider Demographics
NPI:1548242290
Name:EVANS, ROBERT LAPP (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAPP
Last Name:EVANS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3 IRONGATE CENTER
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3471
Mailing Address - Country:US
Mailing Address - Phone:518-793-4409
Mailing Address - Fax:518-793-5886
Practice Address - Street 1:3 IRONGATE CENTER
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3471
Practice Address - Country:US
Practice Address - Phone:518-793-4409
Practice Address - Fax:518-793-5886
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00811665Medicaid
NY021200700360OtherFIDELIS
NY10471359OtherCAQH
NY10000596OtherCDPHP
NY00020846401OtherUNIVERA
NY77D831OtherBLUE CROSS BLUE SHIELD
CD1981OtherRAILROAD MEDICARE GROUP #
NY000000056822OtherGHI-HMO
NY000401120002OtherBLUE SHIELD NENY
NY08169OtherMVP
NY00020846401OtherUNIVERA
NY10471359OtherCAQH