MEDICARE: DR. BEVERLY DIANE GATES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	0101033810	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	292276	OTHER	VA	ANTHEM-PARHAM RD
2	66557	OTHER		OPTIMAHEALTH

General Provider Information

NPI Number	:	1255331575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY DIANE GATES MD

Provider Business Mailing Address
First Line	:	PO BOX 36559
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-8011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 E PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4301
Country	:	US
Telephone Number	:	804-747-5675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/10/2007

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