Active NPI
George H Evancho, DPM
- Podiatrist
- Chesapeake, VA
National Provider Identifier
1487653440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 0103000375
- Practice address
- 632 Cedar Rd
Suite B
Chesapeake, VA 23322-8376 - Phone
- (757) 547-0123
- Fax
- (757) 547-2412
- NPI assigned
- Jul 20, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 0103000375 | VA | Primary |
| Podiatrist | 213E00000X | 179 | NC |
Addresses
Primary practice location
632 Cedar Rd
Suite B
Chesapeake, VA 23322-8376
Mailing address
632 Cedar Rd
Suite B
Chesapeake, VA 23322-8376
Phone (757) 547-0123
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52487 | Other | VA | OPTIMA |
| 211329 | Other | VA | MAMSI |
| 358171 | Other | VA | ANTHEM |
| 480017876 | Other | VA | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 375 | VA | MD | Psychosomatic Medicine Physician |
| 179 | NC | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259798400000",
"number": "1487653440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 CEDAR RD",
"address_2": "SUITE B",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233228376",
"telephone_number": "757-547-0123",
"fax_number": "757-547-2412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "632 CEDAR RD",
"address_2": "SUITE B",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233228376",
"telephone_number": "757-547-0123",
"fax_number": "757-547-2412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANCHO",
"first_name": "GEORGE",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-20",
"last_updated": "2009-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "VA",
"license": "0103000375",
"primary": true
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NC",
"license": "179",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA",
"identifier": "52487",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "211329",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "358171",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "480017876",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.