1528035532 NPI number — ROY A BEVERIDGE M.D.

Table of content: ROY A BEVERIDGE M.D. (NPI 1528035532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528035532 NPI number — ROY A BEVERIDGE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEVERIDGE
Provider First Name:
ROY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528035532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8503 ARLINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-280-5390
Provider Business Mailing Address Fax Number:
703-280-9596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8503 ARLINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-280-5390
Provider Business Practice Location Address Fax Number:
703-280-9596
Provider Enumeration Date:
03/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  010142071 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500617-500590 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 500617-4354321 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 504730 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006080901 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0870004 . This is a "BCBS NCA/CAREFIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "TRICARE/HEALTHNET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "PHCS PPO/POS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5982227005 . This is a "CIGNA PPO/POS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 220665 . This is a "TRIGON/ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 316256 . This is a "MAMSI/OP CHOICE/ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5982227005 . This is a "CIGNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3600043 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "FX COUNTY COMM HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".