Provider Demographics
NPI:1750330304
Name:EDWARDS, BEVERLY EDWARDS (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:EDWARDS
Last Name:EDWARDS
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 1:400 MCGLOHON ST S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3815
Mailing Address - Country:US
Mailing Address - Phone:252-332-3403
Mailing Address - Fax:
Practice Address - Street 1:700 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3547
Practice Address - Country:US
Practice Address - Phone:252-332-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33816208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930147Medicaid
VA241520OtherVIRGINA BLUE CROSS BS
NC561929096OtherFEDERAL TAX ID
NC890160MMedicaid
VA6747655Medicaid
NC30147OtherBLUE CROSS BLUE SHIELD
NC8930147Medicaid