Provider Demographics
NPI:1801867023
Name:EVALES, MARIA ETHEL (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ETHEL
Last Name:EVALES
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Gender:F
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT SPECIALIST
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8053
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:299 CAREW ST STE 126
Practice Address - Street 2:SPRINGFIELD PEDIATRICS
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2304
Practice Address - Country:US
Practice Address - Phone:413-747-5437
Practice Address - Fax:413-747-5433
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA80970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015186OtherNEIGHBORHOOD HEALTH
MA3140423Medicaid
MAPP822OtherHARVARD PILGRIM
MA406094OtherTUFTS
MAJ16171OtherBLUE CROSS
MAJ16171OtherBLUE CROSS
MA3140423Medicaid