Individual provider · NPI-1

Evan Davis, ATC

Emergency Medicine, Sports Medicine · Newington, CT

NPI number1164094942
StatusActive
Last updated in NPPESJul 12, 2021

Details

NPI
1164094942
Entity type
Individual (NPI-1)
Name
Evan Davis
Credential
ATC
Sex
Male
Sole proprietor
Yes
Enumeration date
Jul 12, 2021
Certification date
Jul 12, 2021
Last updated
Jul 12, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207PS0010X Emergency Medicine, Sports Medicine000721CTYes

Practice location

156 Roseleah Ave
Newington, CT 06111-2055

Phone 860-614-2122

Mailing address

156 Roseleah Ave
Newington, CT 06111-2055

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