Healthcare Provider Details

I. General information

NPI: 1528035532
Provider Name (Legal Business Name): ROY A BEVERIDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 ARLINGTON BLVD SUITE 400
FAIRFAX VA
22031-4628
US

IV. Provider business mailing address

8503 ARLINGTON BLVD SUITE 400
FAIRFAX VA
22031-4628
US

V. Phone/Fax

Practice location:
  • Phone: 703-280-5390
  • Fax: 703-280-9596
Mailing address:
  • Phone: 703-280-5390
  • Fax: 703-280-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number010142071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: