Basic Information
| Provider Information | |||||||||
| NPI: | 1801867023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVALES | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ETHEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | PROVIDER ENROLLMENT SPECIALIST | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598053 | ||||||||
| FaxNumber: | 6174213487 | ||||||||
| Practice Location | |||||||||
| Address1: | 299 CAREW ST STE 126 | ||||||||
| Address2: | SPRINGFIELD PEDIATRICS | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011042304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137475437 | ||||||||
| FaxNumber: | 4137475433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 80970 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0015186 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 3140423 | 05 | MA | MEDICAID | PP822 | 01 | MA | HARVARD PILGRIM | OTHER | 406094 | 01 | MA | TUFTS | OTHER | J16171 | 01 | MA | BLUE CROSS | OTHER |