Provider Demographics
NPI:1790754687
Name:CEVALLOS, EDUARDO A (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:A
Last Name:CEVALLOS
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 1:99 N WEST END BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1272
Mailing Address - Country:US
Mailing Address - Phone:215-536-1915
Mailing Address - Fax:215-536-9189
Practice Address - Street 1:99 N WEST END BLVD STE 110
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-536-1915
Practice Address - Fax:215-536-9189
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016392E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006340100001Medicaid
PAE63587Medicare UPIN