Provider Demographics
NPI:1265693501
Name:EVANS, KRISTA E (MD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:E
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE.
Mailing Address - Street 2:UVM MEDICAL CENTER, GENERAL SURGERY
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-1288
Mailing Address - Fax:802-847-7852
Practice Address - Street 1:111 COLCHESTER AVE.
Practice Address - Street 2:UVM MEDICAL CENTER, GENERAL SURGERY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-1288
Practice Address - Fax:802-847-7852
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54009208C00000X
VT042.0013530208C00000X
NC148794390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program