Provider Demographics
NPI:1578657458
Name:MORTIMER, EVAN E (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:E
Last Name:MORTIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10222 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3906
Mailing Address - Country:US
Mailing Address - Phone:410-997-3497
Mailing Address - Fax:
Practice Address - Street 1:201 W PRESTON ST
Practice Address - Street 2:RM 309
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2301
Practice Address - Country:US
Practice Address - Phone:410-767-6718
Practice Address - Fax:410-333-5233
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology