Provider Demographics
NPI:1942294848
Name:RIVERA, CARLOS A (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 WATERS AVE
Mailing Address - Street 2:STE C8
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3825
Mailing Address - Country:US
Mailing Address - Phone:912-352-2606
Mailing Address - Fax:912-352-0623
Practice Address - Street 1:7505 WATERS AVE
Practice Address - Street 2:STE C8
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3825
Practice Address - Country:US
Practice Address - Phone:912-352-2606
Practice Address - Fax:912-352-0623
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA344562085R0202X, 2085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0203X, 2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00469169AMedicaid
SCG34456Medicaid
GA024372OtherBLUE CROSS
GA024372OtherBLUE CROSS
SCG34456Medicaid
GA00469169AMedicaid
SCE849026289Medicare ID - Type UnspecifiedMEDICARE SC