Provider Demographics
NPI:1679736714
Name:BEVELAQUA, ANNA-CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA-CHRISTINA
Middle Name:
Last Name:BEVELAQUA
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 1:1040 UNIVERSITY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2650
Mailing Address - Country:US
Mailing Address - Phone:757-397-6930
Mailing Address - Fax:577-393-4864
Practice Address - Street 1:1040 UNIVERSITY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2650
Practice Address - Country:US
Practice Address - Phone:757-397-6930
Practice Address - Fax:757-393-4864
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265956208100000X, 2081S0010X
VA01012693222081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXVTR1Medicare PIN