Provider Demographics
NPI:1174734313
Name:EVEN, LEROY MILTON (MD)
Entity type:Individual
Prefix:DR
First Name:LEROY
Middle Name:MILTON
Last Name:EVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SUGAR ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-9595
Mailing Address - Country:US
Mailing Address - Phone:570-253-8077
Mailing Address - Fax:570-253-8077
Practice Address - Street 1:185 SUGAR ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-9595
Practice Address - Country:US
Practice Address - Phone:570-253-8077
Practice Address - Fax:570-253-8077
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034739E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice