Provider Demographics
NPI:1740297258
Name:LEITE, BEVERLY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN
Last Name:LEITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50150
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-0150
Mailing Address - Country:US
Mailing Address - Phone:425-228-5228
Mailing Address - Fax:425-228-5733
Practice Address - Street 1:1334 TERRY AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2747
Practice Address - Country:US
Practice Address - Phone:425-228-5228
Practice Address - Fax:425-228-5733
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023539207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1037845Medicaid
AO6374Medicare UPIN
0109520Medicare ID - Type Unspecified