Provider Demographics
NPI:1467594903
Name:BEVERLEY, CORDIA L (MD)
Entity Type:Individual
Prefix:
First Name:CORDIA
Middle Name:L
Last Name:BEVERLEY
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 1:1085 PARK AVE
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1168
Mailing Address - Country:US
Mailing Address - Phone:212-876-1886
Mailing Address - Fax:
Practice Address - Street 1:1085 PARK AVE
Practice Address - Street 2:SUITE 1N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1168
Practice Address - Country:US
Practice Address - Phone:212-876-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130612207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79244Medicare UPIN
NY75A311Medicare PIN