Provider Demographics
NPI:1700889169
Name:ENTWISLE, BEVERLY J (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:J
Last Name:ENTWISLE
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 1:250 PLEASANT STREET
Mailing Address - Street 2:YEAPLE BUILDING
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-228-7200
Mailing Address - Fax:603-228-7307
Practice Address - Street 1:250 PLEASANT STREET
Practice Address - Street 2:YEAPLE BUILDING
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-228-7200
Practice Address - Fax:603-228-7307
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7945207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHH005016OtherTRICARE ID#
NH3016717OtherAETNA ID#
NH25526OtherCIGNA ID#
NH30002613Medicaid
NH371528OtherMVP ID#
NHE14790OtherHARVARD PILGRIM ID#
NH25526OtherCIGNA ID#
NHRE0846Medicare ID - Type Unspecified