Provider Demographics
NPI:1700036241
Name:EVANGELISTA, MARK ANG (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANG
Last Name:EVANGELISTA
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 1:1501 MIDDLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3615
Mailing Address - Country:US
Mailing Address - Phone:302-629-4569
Mailing Address - Fax:302-628-4669
Practice Address - Street 1:1501 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3615
Practice Address - Country:US
Practice Address - Phone:302-629-4569
Practice Address - Fax:302-628-4669
Is Sole Proprietor?:No
Enumeration Date:2008-09-21
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine