Provider Demographics
NPI:1568433662
Name:EVANS, TERRY L (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N431
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-5806
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:200 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3783
Practice Address - Country:US
Practice Address - Phone:724-838-1900
Practice Address - Fax:724-838-5620
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD016531E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA026403OtherHIGHMARK BS
PA11453309OtherCAQH
PA0010651530008Medicaid
PA900004411Medicare PIN
PA026403RJNMedicare PIN
PA026403UUEMedicare PIN
PAP00341018Medicare PIN
PA026403OtherHIGHMARK BS