Provider Demographics
NPI:1023119195
Name:EVANGELISTO, AMY M (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:EVANGELISTO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2301 E. EVESHAM ROAD
Mailing Address - Street 2:BLDG 800, SUITE 115
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4509
Mailing Address - Country:US
Mailing Address - Phone:856-424-5005
Mailing Address - Fax:856-424-4716
Practice Address - Street 1:2301 E. EVESHAM ROAD
Practice Address - Street 2:BLDG 800, SUITE 115
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-424-5005
Practice Address - Fax:856-424-4716
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-05-16
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07800100207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40968OtherUNIVERSITY HEALTH PLAN
NJ8348415OtherCIGNA
NJ010006995OtherAMERICHOICE
NJ2428351OtherUNITED HEALTCARE
NJ3655581OtherAETNA USHEALTHCARE
NJ1661111OtherAMERIHEALTH PPO PABS
NJ3K6155OtherHEALTHNET, INC
NJP3556050OtherOXFORD HEALTH PLAN
NJ2337004000OtherAMERIHEALTH HMO
NJP3556050OtherOXFORD HEALTH PLAN
NJ2428351OtherUNITED HEALTCARE
NJ40968OtherUNIVERSITY HEALTH PLAN