Provider Demographics
NPI:1821313115
Name:BEVERDAM FAMILY MEDICINE, LTD
Entity Type:Organization
Organization Name:BEVERDAM FAMILY MEDICINE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-449-1717
Mailing Address - Street 1:16151A TRAINHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAVERDAM
Mailing Address - State:VA
Mailing Address - Zip Code:23015
Mailing Address - Country:US
Mailing Address - Phone:804-449-1717
Mailing Address - Fax:804-449-1710
Practice Address - Street 1:16151A TRAINHAM ROAD
Practice Address - Street 2:
Practice Address - City:BEAVERDAM
Practice Address - State:VA
Practice Address - Zip Code:23015-1301
Practice Address - Country:US
Practice Address - Phone:804-449-1717
Practice Address - Fax:804-449-1710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERDAM FAMILY MEDICINE, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty