Provider Demographics
NPI:1275604647
Name:BEVERLY, CLINTON STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:STEVEN
Last Name:BEVERLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 THOMSON DRIVE
Mailing Address - Street 2:CENTRAL VIRGINIA SURGERY
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501
Mailing Address - Country:US
Mailing Address - Phone:434-947-3933
Mailing Address - Fax:434-947-3988
Practice Address - Street 1:1906 THOMSON DRIVE
Practice Address - Street 2:CENTRAL VIRGINIA SURGERY
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501
Practice Address - Country:US
Practice Address - Phone:434-947-3933
Practice Address - Fax:434-947-3988
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054250208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA303465OtherWELL CARE PROVIDER #
GAP00143081OtherRAILROAD MEDICARE #
GA913938883AOtherPEACH STATE PROVIDER #
GA913938883AMedicaid
GA52143398OtherBCBS PROVIDER #
GAH42219Medicare UPIN
GA913938883AOtherPEACH STATE PROVIDER #