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General NPI Number Information
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NPI Number | 1447240312
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Entity Type | Individual
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Provider Name | MICHAEL LELAND BEAVERS DO
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1502 PEMBERTON DR UNIT D
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City | SALISBURY
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State | MD
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Zip | 21801
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Country | US
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Telephone | 410-641-9450
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Fax | 410-641-9515
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Provider Business Mailing Address
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Address Line | 8678 SPUR LN
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City | EASTON
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State | MD
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Zip | 21601
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Country | US
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Telephone | 410-641-9450
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Fax | 410-641-9515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | H0057008
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License Number State | MD
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