Individual
DR. CHARLES DAVID EVANCHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 CORPORATE CENTER DR STE 100, CAMP HILL, PA 17011-1758
(717) 763-1174
(717) 763-8960
Mailing address
PO BOX 750, SCRANTON, PA 18501-0750
(570) 346-7797
(570) 342-9802
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
MD037208E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010811750006
—
PA
01
—
220017922
RR MEDICARE
PA
Enumeration date
09/19/2005
Last updated
07/23/2021
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