Healthcare Provider Details

I. General information

NPI: 1275069817
Provider Name (Legal Business Name): BEVERLY A. HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E. MARSHALL ST BOX 980251
RICHMOND VA
23298
US

IV. Provider business mailing address

1250 E. MARSHALL ST BOX 980251
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9626
  • Fax: 804-828-5856
Mailing address:
  • Phone: 804-828-9626
  • Fax: 804-828-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101266557
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: