Provider Demographics
NPI:1659437549
Name:EVANS, NATHANIEL RUTHERFORD II (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:RUTHERFORD
Last Name:EVANS
Suffix:II
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 1:640 BEVERLY RANCOCAS RD
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3736
Mailing Address - Country:US
Mailing Address - Phone:609-835-9555
Mailing Address - Fax:609-835-2313
Practice Address - Street 1:640 BEVERLY RANCOCAS RD
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3736
Practice Address - Country:US
Practice Address - Phone:609-835-9555
Practice Address - Fax:609-835-2313
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03525700207P00000X, 207R00000X
PAMD020306-E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-272-3843OtherTAX ID - EIN
PAD19711Medicare UPIN
NJD19711Medicare UPIN
PA119711Medicare UPIN