Provider Demographics
NPI:1689175770
Name:EVANS, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 DONNELL DR APT 403
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3911
Mailing Address - Country:US
Mailing Address - Phone:202-270-7034
Mailing Address - Fax:
Practice Address - Street 1:3719 DONNELL DR APT 403
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-3911
Practice Address - Country:US
Practice Address - Phone:202-270-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant