Provider Demographics
NPI:1396543815
Name:ONEILL, EVAN J
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:J
Last Name:ONEILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 PADWA RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT MOUNT
Mailing Address - State:PA
Mailing Address - Zip Code:18453-4690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 PADWA RD
Practice Address - Street 2:
Practice Address - City:PLEASANT MOUNT
Practice Address - State:PA
Practice Address - Zip Code:18453-4690
Practice Address - Country:US
Practice Address - Phone:570-642-1204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA1063495207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services