Provider Demographics
NPI:1710039276
Name:EVANS, CATHERINE JOANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:JOANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5701
Mailing Address - Country:US
Mailing Address - Phone:304-243-6390
Mailing Address - Fax:304-243-7044
Practice Address - Street 1:1079 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5701
Practice Address - Country:US
Practice Address - Phone:304-243-6390
Practice Address - Fax:304-243-7044
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0903179Medicaid
WV0053460000Medicaid
WV0053460000Medicaid
WVEV4105311Medicare ID - Type Unspecified