Provider Demographics
NPI:1396055026
Name:BEYDER, BIANCA (PA-C)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:BEYDER
Suffix:
Gender:F
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:PO BOX 531797
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-1797
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:2240 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4725
Practice Address - Country:US
Practice Address - Phone:704-834-2450
Practice Address - Fax:704-671-5331
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC0010-03633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396055026Medicaid
NC8102846Medicaid
NCNC8905KMedicare PIN
NCNC8905EMedicare PIN
NCNC8905AMedicare PIN
NCNC8905FMedicare PIN
NCNC8905NMedicare PIN
NC1396055026Medicaid
NCNC8905PMedicare PIN