Provider Demographics
NPI:1134113871
Name:EVANS, REGINA RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:RAE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6522
Mailing Address - Country:US
Mailing Address - Phone:888-467-1117
Mailing Address - Fax:888-990-3903
Practice Address - Street 1:102 NEW EDITION CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4449
Practice Address - Country:US
Practice Address - Phone:919-375-1514
Practice Address - Fax:833-314-0392
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21761101Y00000X, 207Q00000X, 207V00000X
NC2003011102084P0800X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6613Medicaid
SCGP7038Medicaid
NCP00106029OtherPALMETTO GBA
NC208618DOtherUNITED HEALTHCARE
NCD4406OtherMEDCOST
NC89135VEMedicaid
NC89015W1Medicaid
NCP00106029OtherPALMETTO GBA
NC2022295AMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE