Provider Demographics
NPI:1831172261
Name:FEIBUSCH, EVAN L (MD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:L
Last Name:FEIBUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 S. EAGLE ROAD
Mailing Address - Street 2:PMB 366
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-0186
Mailing Address - Country:US
Mailing Address - Phone:215-867-9010
Mailing Address - Fax:866-246-9305
Practice Address - Street 1:502 E WASHINGTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-2131
Practice Address - Country:US
Practice Address - Phone:215-867-9010
Practice Address - Fax:866-246-9305
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4219472084F0202X
NJ25MA068597002084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH56189Medicare UPIN
NJ055700Medicare ID - Type Unspecified