Provider Demographics
NPI:1760579031
Name:BEVARD, WARREN EDWARD (DPM)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:EDWARD
Last Name:BEVARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 SOLAREX CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8678
Mailing Address - Country:US
Mailing Address - Phone:301-698-9260
Mailing Address - Fax:301-698-8962
Practice Address - Street 1:604 SOLAREX CT
Practice Address - Street 2:SUITE 103
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8678
Practice Address - Country:US
Practice Address - Phone:301-698-9260
Practice Address - Fax:301-698-8962
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00327213E00000X
MD01248213E00000X
PASC003667L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA198257WRYMedicare PIN
MDQ174Medicare PIN
PA198257ZBCRMedicare PIN
MDU66453Medicare UPIN
WV0825554Medicare PIN