Provider Demographics
NPI:1033654264
Name:ADULT AND PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:ADULT AND PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-484-2002
Mailing Address - Street 1:3800 POPLAR HILL RD
Mailing Address - Street 2:STE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5518
Mailing Address - Country:US
Mailing Address - Phone:757-484-2001
Mailing Address - Fax:757-484-2182
Practice Address - Street 1:3800 POPLAR HILL RD
Practice Address - Street 2:STE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5518
Practice Address - Country:US
Practice Address - Phone:757-484-2001
Practice Address - Fax:757-484-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-25
Last Update Date:2016-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010060133Medicaid