Provider Demographics
NPI:1578629598
Name:RADICE, BEVERLY ANN (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:RADICE
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 1:12 PERRINE PATH
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2950
Mailing Address - Country:US
Mailing Address - Phone:609-282-1451
Mailing Address - Fax:609-282-3488
Practice Address - Street 1:1300 MERRILL LYNCH DR BLDG 3
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-4124
Practice Address - Country:US
Practice Address - Phone:609-274-8879
Practice Address - Fax:609-274-0126
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine