Provider Demographics
NPI:1609853118
Name:SCHIFF, EVAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:L
Last Name:SCHIFF
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 1:36 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3801
Mailing Address - Country:US
Mailing Address - Phone:860-677-5533
Mailing Address - Fax:860-678-1305
Practice Address - Street 1:36 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3801
Practice Address - Country:US
Practice Address - Phone:860-677-5533
Practice Address - Fax:860-678-1305
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001430925Medicaid
CT001430925Medicaid
I28213Medicare UPIN
CT110009497Medicare PIN
CTD900050917Medicare PIN