MEDICARE: DR. FREDERICK PAUL BEAVERS 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	2086S0129X	Vascular Surgery Physician	D60615	MD

General Provider Information

NPI Number	:	1740287606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK PAUL BEAVERS M.D.

Provider Business Mailing Address
First Line	:	106 IRVING ST NW
Second Line	:	POB NORTH 3150
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2927
Country	:	US
Telephone Number	:	202-877-0275
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 IRVING ST NW
Second Line	:	POB, SUITE 3150 NORTH
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2927
Country	:	US
Telephone Number	:	202-877-8050
Fax Number	:	202-877-0456

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	12/29/2016

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