Provider Demographics
NPI:1366431660
Name:RIVERA, MILAGROS (MD)
Entity type:Individual
Prefix:DR
First Name:MILAGROS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4913
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-7850
Practice Address - Street 1:102 BRYAN WOODS ROAD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410
Practice Address - Country:US
Practice Address - Phone:912-898-1122
Practice Address - Fax:912-898-9944
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000327323OtherANTHEM - NCMA
50003508OtherPASSPORT - NCMA
KY1200033OtherCHA / NCMA
KY4423779OtherCIGNA / NCMA
KY64337553Medicaid
KYP00136585OtherRRMCR - NCMA
040477OtherSIHO - NCMA
FL914812400Medicaid
2444940000OtherPAD - NCMA
IN200482440Medicaid
040477OtherSIHO - NCMA
KY1200033OtherCHA / NCMA