Organization
EVAN P PROVISOR MD PC
Active
Other names
Sharon Surgical Group
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN PAUL PROVISOR MD (PRESIDENT)
(860) 364-0226
Entity
Organization
Contact information
Practice address
29 HOSPITAL HILL RD, SUITE 1600, SHARON, CT 06069-2095
(860) 364-0226
(860) 364-0875
Mailing address
PO BOX 786, SHARON, CT 06069-0786
(860) 364-0226
(860) 364-0875
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
CT
Other
Enumeration date
12/23/2005
Last updated
08/10/2007
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