Healthcare Provider Details

I. General information

NPI: 1851888275
Provider Name (Legal Business Name): EVELYN SANTOS GUERRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELYN VIEIRA SANTOS

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

5220 GREENS DAIRY RD
RALEIGH NC
27616-4612
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5047
  • Fax:
Mailing address:
  • Phone: 919-781-1487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2024-00767
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.139854
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101281737
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: