Provider Demographics
NPI:1508821174
Name:BEVERLY, VERNIS L (MD)
Entity Type:Individual
Prefix:
First Name:VERNIS
Middle Name:L
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 1:3800 POPLAR HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5522
Mailing Address - Country:US
Mailing Address - Phone:757-484-2001
Mailing Address - Fax:757-484-2182
Practice Address - Street 1:3800 POPLAR HILL RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5522
Practice Address - Country:US
Practice Address - Phone:757-484-2001
Practice Address - Fax:757-484-2182
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101224920208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010060133Medicaid
VA010003202Medicaid
VA010060169Medicaid
C09064OtherMEDICARE GROUP NUMBER
C09064OtherMEDICARE GROUP NUMBER
VAH83127Medicare UPIN
VA001489P95Medicare PIN