Provider Demographics
NPI:1659301430
Name:BEAVERS, TAMMY J (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 MANHATTAN SQ STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6262
Mailing Address - Country:US
Mailing Address - Phone:757-838-6335
Mailing Address - Fax:757-838-0612
Practice Address - Street 1:9 MANHATTAN SQ STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6262
Practice Address - Country:US
Practice Address - Phone:757-838-6335
Practice Address - Fax:757-838-0612
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101229025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659301430Medicaid
C05763OtherMEDICARE CLINIC PTAN
VAC10736OtherMEDICARE GROUP PTAN