MEDICARE: BEVERDAM FAMILY MEDICINE, LTD

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	207Q00000X	Family Medicine Physician	0101230106	VA

General Provider Information

NPI Number	:	1821313115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERDAM FAMILY MEDICINE, LTD

Provider Business Mailing Address
First Line	:	16151A TRAINHAM ROAD
Second Line	:
City	:	BEAVERDAM
State	:	VA
Zip	:	23015
Country	:	US
Telephone Number	:	804-449-1717
Fax Number	:	804-449-1710

Provider Business Practice Location Address
First Line	:	16151A TRAINHAM ROAD
Second Line	:
City	:	BEAVERDAM
State	:	VA
Zip	:	23015-1301
Country	:	US
Telephone Number	:	804-449-1717
Fax Number	:	804-449-1710

Authorized Official
Title or Position	:	CFO
Name	:	MRS. CANDACE G BITTNER
Credential	:
Telephone Number	:	804-449-1717

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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