Individual
GREGORY EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3107 W DIAMOND ST, PHILADELPHIA, PA 19121-1111
(610) 803-4928
Mailing address
3107 W DIAMOND ST, PHILADELPHIA, PA 19121-1111
(610) 803-4928
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
27913601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A4138662
—
PA
Enumeration date
06/01/2015
Last updated
06/01/2015
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