Healthcare Provider Details

I. General information

NPI: 1952644247
Provider Name (Legal Business Name): KEHVON BEKAREV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEHVON CLARK MD

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 POSTAL DR
ROANOKE VA
24018-6438
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-4453
  • Fax:
Mailing address:
  • Phone: 540-224-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number283261
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA153485
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101283050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: