Provider Demographics
NPI:1508807025
Name:TROMBLEY, BEVERLY A (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:TROMBLEY
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 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2232
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2232
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN322482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34508700Medicaid
MN100720OtherUCARE
MNHP14576OtherHEALTHPARTNERS
IA0769703Medicaid
MN50233TROtherBLUE CROSS
MN909290100Medicaid
MN1014488OtherPREFERRED ONE
MN23021OtherAMERICA'S PPO
MN299G1TROtherBLUE CROSS
MN300087440OtherRAILROAD MEDICARE MN
MN300002901Medicare PIN
MN50233TROtherBLUE CROSS
MN299G1TROtherBLUE CROSS
MNA94170Medicare UPIN