Provider Demographics
NPI:1104851302
Name:EVANS, SCOTT M (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVERSIDE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1304
Mailing Address - Country:US
Mailing Address - Phone:603-883-0091
Mailing Address - Fax:603-881-3739
Practice Address - Street 1:17 RIVERSIDE ST
Practice Address - Street 2:STE 101
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1304
Practice Address - Country:US
Practice Address - Phone:603-883-0091
Practice Address - Fax:603-881-3739
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1861558645OtherNPI, PROVIDER LOCATION
NH1881772242OtherNPI, PROVIDER LOCATION
NH1922164797OtherNPI, PROVIDER LOCATION
NH1932256914OtherNPI, PROVIDER LOCATION
NH1801952692OtherNPI, PROVIDER LOCATION
NH1841320207OtherNPI, PROVIDER LOCATION
NH30330718Medicaid
NH1861558645OtherNPI, PROVIDER LOCATION
P00415Medicare UPIN
NH0132510004Medicare NSC
NH0132510001Medicare NSC
AP1207Medicare PIN
NH1881772242OtherNPI, PROVIDER LOCATION
NH0132510005Medicare NSC