MEDICARE: CLAY E BEVERIDGE MD

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	207R00000X	Internal Medicine Physician	0101056135	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00309631	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407807431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAY E BEVERIDGE MD

Provider Business Mailing Address
First Line	:	229 WADSWORTH DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4510
Country	:	US
Telephone Number	:	804-228-3627
Fax Number	:	804-560-1312

Provider Business Practice Location Address
First Line	:	229 WADSWORTH DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4510
Country	:	US
Telephone Number	:	804-228-3627
Fax Number	:	804-560-1312

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	09/13/2024

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Directions to “ CLAY E BEVERIDGE MD” Practice Location

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