Provider Demographics
NPI:1528035532
Name:BEVERIDGE, ROY A (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:BEVERIDGE
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 1:8503 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4628
Mailing Address - Country:US
Mailing Address - Phone:703-280-5390
Mailing Address - Fax:703-280-9596
Practice Address - Street 1:8503 ARLINGTON BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4628
Practice Address - Country:US
Practice Address - Phone:703-280-5390
Practice Address - Fax:703-280-9596
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010142071207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA500617-500590OtherAETNA HMO
VA500617-4354321OtherAETNA PPO
VA504730OtherNCPPO
VA006080901Medicaid
VA0870004OtherBCBS NCA/CAREFIRST
VA541795091OtherTRICARE/HEALTHNET
VA541795091OtherPHCS PPO/POS
VA5982227005OtherCIGNA PPO/POS
VA220665OtherTRIGON/ANTHEM
VA316256OtherMAMSI/OP CHOICE/ALLIANCE
VA5982227005OtherCIGNA HMO
VA3600043OtherUNITED HEALTHCARE
VA541795091OtherFX COUNTY COMM HEALTH
VA504730OtherNCPPO
VAD76145Medicare UPIN
VA006080901Medicaid
VA830000032Medicare PIN