Healthcare Provider Details

I. General information

NPI: 1609731611
Provider Name (Legal Business Name): NORTH BEVERLY FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 DUNHAM RD STE 2500
BEVERLY MA
01915-1844
US

IV. Provider business mailing address

11 EVERGREEN RD
RAYMOND ME
04071-5534
US

V. Phone/Fax

Practice location:
  • Phone: 207-671-0638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA MACVANE
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 207-671-0638