=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164493490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL EVANS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2006
-----------------------------------------------------
Last Update Date | 07/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 CASHMERE CT
-----------------------------------------------------
City | CRANBERRY TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16066-3853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-580-0957
-----------------------------------------------------
Fax | 412-774-2144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 CASHMERE CT
-----------------------------------------------------
City | CRANBERRY TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16066-3853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-580-0957
-----------------------------------------------------
Fax | 412-774-2144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | MD031717E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------