Provider Demographics
NPI:1932113826
Name:EVANS, JAY MARK (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MARK
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:8200 MEADOWBRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2331
Practice Address - Country:US
Practice Address - Phone:804-730-2121
Practice Address - Fax:804-730-0563
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101046958207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6408508Medicaid
MC12434Medicare PIN
538695Medicare PIN
0962280006Medicare NSC
VA6408508Medicaid
C10465Medicare PIN
VA6408508Medicaid