Provider Demographics
NPI:1609908912
Name:CORRY, BEVERLY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ELIZABETH
Last Name:CORRY
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 1:1621 W BUFORD ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1102
Mailing Address - Country:US
Mailing Address - Phone:864-488-9247
Mailing Address - Fax:
Practice Address - Street 1:1621 W BUFORD ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1102
Practice Address - Country:US
Practice Address - Phone:864-488-9247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11686208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C60721Medicare UPIN