Provider Demographics
NPI:1619266137
Name:GERSHATER, EVAN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JAMES
Last Name:GERSHATER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6970
Mailing Address - Country:US
Mailing Address - Phone:301-431-2225
Mailing Address - Fax:410-510-1844
Practice Address - Street 1:7505 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6970
Practice Address - Country:US
Practice Address - Phone:301-431-2225
Practice Address - Fax:410-510-1844
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011997-1111N00000X
MDS03728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor