Provider Demographics
NPI:1730135203
Name:MCEVOY, COLSTON FREEMAN (MD)
Entity Type:Individual
Prefix:
First Name:COLSTON
Middle Name:FREEMAN
Last Name:MCEVOY
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:STE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE A140
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-5125
Practice Address - Fax:864-241-9201
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23678208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPPROVEDMedicaid
SCAPPROVEDMedicaid
SC100017297OtherRR MEDICARE
SCT79368Medicaid
SC1444618OtherCIGNA
SC576007863048OtherBLUE CHOICE OF SC
SCF547836904Medicare PIN
SC576007863094OtherBCBS OF SC
SCF547837951Medicare PIN