Provider Demographics
NPI:1295708931
Name:MCEVOY, CHARLENE E (MD)
Entity type:Individual
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First Name:CHARLENE
Middle Name:E
Last Name:MCEVOY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:401 PHALEN BLVD
Mailing Address - Street 2:MS 41102D
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-5302
Mailing Address - Country:US
Mailing Address - Phone:651-254-7670
Mailing Address - Fax:651-254-7676
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41102D
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7670
Practice Address - Fax:651-254-7676
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-08-26
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Provider Licenses
StateLicense IDTaxonomies
MN32694207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN955295200Medicaid
MN955295200Medicaid
MN955295200Medicaid