Provider Demographics
NPI:1578606802
Name:RICHARD A. EVANS, M.D., P.A.
Entity Type:Organization
Organization Name:RICHARD A. EVANS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-564-0715
Mailing Address - Street 1:14 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1023
Mailing Address - Country:US
Mailing Address - Phone:207-564-0715
Mailing Address - Fax:207-564-0717
Practice Address - Street 1:14 WINTER ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1023
Practice Address - Country:US
Practice Address - Phone:207-564-0715
Practice Address - Fax:207-564-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013561208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME180290000Medicaid
ME060452OtherANTHEM
MEP00018335OtherRAILROAD MEDICARE
ME5504468OtherAETNA - NON-HMO
ME3128758OtherAETNA - HMO
MEP00018335OtherRAILROAD MEDICARE
MEMM4863Medicare PIN
MEP00018335OtherRAILROAD MEDICARE