Provider Demographics
NPI:1245237791
Name:ROBERTS-ATWATER, BEVERLY LAVERN (DO PHD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LAVERN
Last Name:ROBERTS-ATWATER
Suffix:
Gender:F
Credentials:DO PHD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5915
Mailing Address - Fax:757-446-5969
Practice Address - Street 1:721 FAIRFAX AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-5915
Practice Address - Fax:757-446-5969
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102202910208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG32591Medicare UPIN
VA1245237791OtherUNITED HEALTHCARE
VAPAROtherAETNA
VA10086343OtherOPTIMA HEALTH
VA1245237791Medicaid
VA1245237791OtherCOVENTRY NATIONAL/SOUTHERN HEALTH SERVICES
VAPAROtherVIRGINIA HEALTH NETWORK
NC5918933Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL
VAP01105572Medicare PIN
VA-016OtherTRICARE/CHAMPUS
VA1245237791OtherVIRGINIA PREMIER HEALTH PLAN
VA447835OtherANTHEM BC/BS
VAPAROtherMULTIPLAN
VAPAROtherCIGNA
OHG32591Medicare UPIN