| Evolve | |
|
1055 Summer St Stamford CT 06905-5527 | |
| (203) 504-9758 | |
| (203) 504-9758 |
| Full Name | Evolve |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1055 Summer St, Stamford, Connecticut |
| Authorized Official Name and Position | Thomas Joseph Knightly (OWNER) |
| Authorized Official Contact | 9788571424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolve 1055 Summer St Ste 2 Stamford CT 06905-5527 Ph: (203) 504-9758 | Evolve 1055 Summer St Stamford CT 06905-5527 Ph: (203) 504-9758 |
| NPI Number | 1740916105 |
|---|---|
| Provider Enumeration Date | 07/28/2022 |
| Last Update Date | 09/30/2024 |
| Certification Date | 09/30/2024 |
| Medicare PECOS PAC ID | 9537538244 |
|---|---|
| Medicare Enrollment ID | O20221219001900 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740916105 | NPI | - | NPPES |
| Provider Name | Thomas Knightly |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447771282 PECOS PAC ID: 6901176320 Enrollment ID: I20221219002025 |
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