MEDICARE: DR. ANDREANA LAURA RIVERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZN0500X	Neuropathology Physician	N0404	TX

General Provider Information

NPI Number	:	1699909846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREANA LAURA RIVERA M.D.

Provider Business Mailing Address
First Line	:	410 W 10TH AVE
Second Line	:	4182 GRAVES HALL
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 W 10TH AVE
Second Line	:	4182 GRAVES HALL
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1240
Country	:	US
Telephone Number	:	614-292-8881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2009
Last Update Date	:	05/13/2009

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