Provider Demographics
NPI:1467461251
Name:AUSTIN, BEVERLY A
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:A
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 CONCORD PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1716
Mailing Address - Country:US
Mailing Address - Phone:302-477-1303
Mailing Address - Fax:302-477-1014
Practice Address - Street 1:3916 CONCORD PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1716
Practice Address - Country:US
Practice Address - Phone:302-477-1303
Practice Address - Fax:302-477-1014
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE200400201521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist