Provider Demographics
NPI:1558354969
Name:ACQUAYE, EVELYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:M
Last Name:ACQUAYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11126 CARRINGTON GREEN DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3446
Mailing Address - Country:US
Mailing Address - Phone:845-853-5082
Mailing Address - Fax:
Practice Address - Street 1:11126 CARRINGTON GREEN DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3446
Practice Address - Country:US
Practice Address - Phone:804-754-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242724207L00000X
NY242259207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043365299Medicaid
VA1558354969Medicaid
VA1548443153Medicaid
NY02525973Medicaid
DC126619YRNMedicare PIN
VA1043365299Medicaid
VAMC10376Medicare PIN
NYH77654Medicare UPIN