Provider Demographics
NPI:1164493490
Name:EVANS, CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
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 1:213 CASHMERE CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3853
Mailing Address - Country:US
Mailing Address - Phone:412-580-0957
Mailing Address - Fax:412-774-2144
Practice Address - Street 1:213 CASHMERE CT
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-3853
Practice Address - Country:US
Practice Address - Phone:412-580-0957
Practice Address - Fax:412-774-2144
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-07-24
Deactivation Date:2017-08-11
Deactivation Code:
Reactivation Date:2019-07-24
Provider Licenses
StateLicense IDTaxonomies
PAMD031717E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000972439Medicaid
PAE52747Medicare UPIN
PA110042471Medicare PIN
PA000972439Medicaid