Provider Demographics
NPI:1952364374
Name:KARDON, EVAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:P
Last Name:KARDON
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 1:12820 LINDLEY DRIVE
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING SERVICES
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614
Mailing Address - Country:US
Mailing Address - Phone:919-616-1552
Mailing Address - Fax:
Practice Address - Street 1:12820 LINDLEY DRIVE
Practice Address - Street 2:CREDENTIALING/PAYER CONTRACTING SERVICES
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-616-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39834207R00000X
VA0101240858207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC894780AMedicaid
12362121OtherCAQH
NC894780AMedicaid
NC2155340YMedicare ID - Type Unspecified