Evan Paul Provisor, MD
Evan Paul Provisor is a Surgery Physician provider (Surgery) practicing in Southbridge, MA, registered in the NPPES registry with NPI 1366427429 since 2005. The credential MD stands for Doctor of Medicine.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1366427429 |
|---|---|
| Entity type | Individual (Type 1) |
| Name | Evan Paul Provisor |
| Credential | MD |
| Sex | Male |
| Practice address | 94 SOUTH ST, Southbridge, MA, 01550 |
| Phone | 5087646966 |
| Fax | 5087642457 |
| Enumeration date | 2005-12-13 |
| Last updated in NPPES | 2011-12-21 |
Taxonomy & licenses
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 208600000X | Surgery Physician | Primary | 237945 | MA |
MD — Doctor of Medicine: A physician who completed medical school (allopathic medicine), residency training, and state licensure. About the MD credential
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2160307 | Medicaid | MA | — |
Copy-ready billing details
Provider: Evan Provisor, MD NPI: 1366427429 Taxonomy: 208600000X (Surgery Physician) Address: 94 SOUTH ST, Southbridge, MA, 01550
Other providers at this practice address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1477548915 | Richard Manolian | Individual | Podiatrist | Southbridge, MA |
| 1205821410 | Charles Sommer | Individual | Orthopaedic Surgery Physician | Southbridge, MA |
| 1780672105 | Russell Donnelly | Individual | Orthopaedic Surgery Physician | Southbridge, MA |
| 1598743569 | Kevin Traina | Individual | Physician Assistant | Southbridge, MA |
| 1073585378 | Stephen Hilborn | Individual | Surgery Physician | Southbridge, MA |
| 1255308672 | Young-Ho Oh | Individual | Orthopaedic Surgery Physician | Southbridge, MA |
| 1881663953 | Joseph Veneziano | Individual | Orthopaedic Surgery Physician | Southbridge, MA |
| 1154390995 | Konstantino Avradopoulos | Individual | Surgery Physician | Southbridge, MA |
Verify this record
Cross-check NPI 1366427429 against the authoritative CMS record: view Evan Paul Provisor on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
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Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2011-12-21.