Healthcare Provider Details

I. General information

NPI: 1740287606
Provider Name (Legal Business Name): FREDERICK PAUL BEAVERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW POB, SUITE 3150 NORTH
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

106 IRVING ST NW POB NORTH 3150
WASHINGTON DC
20010-2927
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8050
  • Fax: 202-877-0456
Mailing address:
  • Phone: 202-877-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD60615
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: