Provider Demographics
NPI:1295955730
Name:TREAKLE, EVELYN YVONNE (MD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:YVONNE
Last Name:TREAKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:902 OTHMAN DRIVE
Mailing Address - Street 2:TANTALLON NORTH
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:301-292-4717
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVENUE
Practice Address - Street 2:HOWARD UNIVERSITY HOSPITAL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC14020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B95119Medicare UPIN