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NPI Code Detail

MEDICARE: ANNA-CHRISTINA BEVELAQUA MD

MEDICARE: ANNA-CHRISTINA BEVELAQUA 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
1208100000XPhysical Medicine & Rehabilitation Physician265956NY
22081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician265956NY
32081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician0101269322VA

General Provider Information

NPI Number : 1679736714
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA-CHRISTINA BEVELAQUA MD
Provider Business Mailing Address
First Line : 1040 UNIVERSITY BLVD STE 200
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23703-2650
Country : US
Telephone Number : 757-397-6930
Fax Number : 577-393-4864
Provider Business Practice Location Address
First Line : 1040 UNIVERSITY BLVD STE 200
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23703-2650
Country : US
Telephone Number : 757-397-6930
Fax Number : 757-393-4864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2008
Last Update Date : 06/28/2021

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