Evan Davis, ATC

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

000721 Issued in CT

Practice address

156 Roseleah Ave
Newington, CT 06111-2055

Phone

(860) 614-2122

NPI assigned

Jul 12, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1164094942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 ROSELEAH AVE",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 ROSELEAH AVE",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112055",
            "telephone_number": "860-614-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "EVAN",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "CT",
            "license": "000721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Maria Daigle
• Kim L Daley
• Damato Chiropractic Center, L L C
• Amy Kathryn Damato, OTR/L
• Shiri Ann Dauch, LCSW
• Jonathan Davis, ATC
• Kathleen Davis, MS
• Sharon Davis, RN
• Shelby Davis, LPC
• Christina Angelika Davison

• Sports Medicine (Emergency Medicine) Physician in Newington, CT
• Providers in Newington, CT by specialty
• Sports Medicine (Emergency Medicine) Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.