Healthcare Provider Details

I. General information

NPI: 1508821174
Provider Name (Legal Business Name): VERNIS L. BEVERLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 POPLAR HILL RD STE A
CHESAPEAKE VA
23321-5522
US

IV. Provider business mailing address

3800 POPLAR HILL RD STE A
CHESAPEAKE VA
23321-5522
US

V. Phone/Fax

Practice location:
  • Phone: 757-484-2001
  • Fax: 757-484-2182
Mailing address:
  • Phone: 757-484-2001
  • Fax: 757-484-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101224920
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101224920
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: