Provider Demographics
NPI:1972647832
Name:GOODE-KANAWATI, BEVERLY ROBIN (DO)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ROBIN
Last Name:GOODE-KANAWATI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 CREEDMOOR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1687
Mailing Address - Country:US
Mailing Address - Phone:919-844-4552
Mailing Address - Fax:919-844-4556
Practice Address - Street 1:6511 CREEDMOOR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1687
Practice Address - Country:US
Practice Address - Phone:919-844-4552
Practice Address - Fax:919-844-4556
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501076207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCAO1716Medicare UPIN