Provider Demographics
NPI:1740287606
Name:BEAVERS, FREDERICK PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:PAUL
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:POB NORTH 3150
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-877-0275
Mailing Address - Fax:
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:POB, SUITE 3150 NORTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-8050
Practice Address - Fax:202-877-0456
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD606152086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H26516Medicare UPIN
012912H49Medicare ID - Type Unspecified