MEDICARE: VERNIS L. BEVERLY M.D.

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	208000000X	Pediatrics Physician	0101224920	VA
2	207R00000X	Internal Medicine Physician	0101224920	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	C09064	OTHER		MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508821174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNIS L. BEVERLY M.D.

Provider Business Mailing Address
First Line	:	3800 POPLAR HILL RD STE A
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5522
Country	:	US
Telephone Number	:	757-484-2001
Fax Number	:	757-484-2182

Provider Business Practice Location Address
First Line	:	3800 POPLAR HILL RD STE A
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5522
Country	:	US
Telephone Number	:	757-484-2001
Fax Number	:	757-484-2182

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	02/11/2021

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Directions to “ VERNIS L. BEVERLY M.D.” Practice Location

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