Provider Demographics
NPI:1568453181
Name:MCEVOY, VICTORIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:R
Last Name:MCEVOY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:40 SECOND AVE
Practice Address - Street 2:STE 400 MASS GENERAL MEDICAL GROUP WALTHAM
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:781-522-9000
Practice Address - Fax:781-522-9095
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA42853208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA735311OtherTUFTS HEALTH PLAN
MA2061643Medicaid
MAC07103OtherBCBS MA
MA2061643Medicaid
E27746Medicare UPIN