Individual
VIRGINIA ANN EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14519 DETROIT AVE, LAKEWOOD, OH 44107-4316
(216) 521-4200
Mailing address
16500 KENNETH LN, LAKEWOOD, OH 44107-1132
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35041617E
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0404744
—
OH
01
—
930022100
MEDICARE TRAVELERS RR-GA
OH
01
—
942460636259
CARESOURCE
OH
Enumeration date
06/08/2006
Last updated
04/14/2010
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