1295758803 NPI number — LYDIA M EVANS M.D.

Table of content: LYDIA M EVANS M.D. (NPI 1295758803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295758803 NPI number — LYDIA M EVANS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
LYDIA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295758803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 KING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPPAQUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10514-3461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-238-1500
Provider Business Mailing Address Fax Number:
914-238-8191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPPAQUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10514-3461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-238-1500
Provider Business Practice Location Address Fax Number:
914-238-8191
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  153287 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5C6087 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0486480 . This is a "AETNA/U.S.HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WP518 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 39H78 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com