Provider Demographics
NPI:1336135532
Name:CARL, BEVERLY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:A
Last Name:CARL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2998
Mailing Address - Country:US
Mailing Address - Phone:724-728-8840
Mailing Address - Fax:724-728-8308
Practice Address - Street 1:500 MARKET ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2998
Practice Address - Country:US
Practice Address - Phone:724-728-8840
Practice Address - Fax:724-728-8308
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024971E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010526470001Medicaid
PAC31670Medicare UPIN
PA143186LLSMedicare ID - Type Unspecified