Provider Demographics
NPI:1588643613
Name:BEVIN, AVERY A (MD)
Entity Type:Individual
Prefix:DR
First Name:AVERY
Middle Name:A
Last Name:BEVIN
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 1:6781 PARKER FARM DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3161
Mailing Address - Country:US
Mailing Address - Phone:910-763-1555
Mailing Address - Fax:910-762-4726
Practice Address - Street 1:6781 PARKER FARM DR STE 300
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3161
Practice Address - Country:US
Practice Address - Phone:910-763-1555
Practice Address - Fax:910-762-4726
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60313749207N00000X
WAMD60313749207N00000X
NC200501773207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588643613Medicaid
NC141R1OtherBCBS FEDERAL
NCP00293029OtherRR MEDICARE
NC141R1OtherBCBS NC
WA2029984Medicaid
NC2050685OtherMEDICARE TYPE UNSPECIFIED
NC141R1OtherBCBS STATE