Provider Demographics
NPI:1821097510
Name:BEARDSLEY, JOSHUA JEREMIAH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JEREMIAH
Last Name:BEARDSLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S HERLONG AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3399
Mailing Address - Country:US
Mailing Address - Phone:803-327-8500
Mailing Address - Fax:803-327-8505
Practice Address - Street 1:200 S HERLONG AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3399
Practice Address - Country:US
Practice Address - Phone:803-327-8500
Practice Address - Fax:803-327-8505
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103940363A00000X
SCPA936363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00193752OtherRAILROAD MEDICARE
SCAA64236191Medicare PIN
P66797Medicare UPIN
NC2759431Medicare PIN