Provider Demographics
NPI:1588666416
Name:EVANS, LEONARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:E
Last Name:EVANS
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 1:5200 CENTRE AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1300
Mailing Address - Country:US
Mailing Address - Phone:412-681-4989
Mailing Address - Fax:412-681-5117
Practice Address - Street 1:5200 CENTRE AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1300
Practice Address - Country:US
Practice Address - Phone:412-681-4989
Practice Address - Fax:412-681-5117
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019805E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008638370004Medicaid
PA0008638370004Medicaid
PAC28656Medicare UPIN