Basic Information
| Provider Information | |||||||||
| NPI: | 1821073289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST | ||||||||
| Address2: | FL 3 | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457773569 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | WEST NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109941965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453545000 | ||||||||
| FaxNumber: | 8453549469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 1643911 | NY | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.