Provider Demographics
NPI:1225096373
Name:CAVROS, EVIE K (MD)
Entity Type:Individual
Prefix:
First Name:EVIE
Middle Name:K
Last Name:CAVROS
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 1:7015C MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3253
Mailing Address - Country:US
Mailing Address - Phone:703-971-6900
Mailing Address - Fax:703-971-9184
Practice Address - Street 1:7015C MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3253
Practice Address - Country:US
Practice Address - Phone:703-971-6900
Practice Address - Fax:703-971-9184
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051423208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6734006Medicaid
VA6714421Medicaid
VA6734006Medicaid