Provider Demographics
NPI:1962469437
Name:UNIACKE, BEVERLEY P (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:P
Last Name:UNIACKE
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 1:1 TRINITY DR E STE 120
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-8522
Mailing Address - Country:US
Mailing Address - Phone:717-432-5430
Mailing Address - Fax:717-432-9296
Practice Address - Street 1:1 TRINITY DR E
Practice Address - Street 2:SUITE 120
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-8522
Practice Address - Country:US
Practice Address - Phone:717-432-5430
Practice Address - Fax:717-432-9296
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053374L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015924340002Medicaid
PAP859633OtherGATEWAY
PA579133OtherAETNA
PA0015924340002Medicaid
PAG41387Medicare UPIN