Provider Demographics
NPI:1770719015
Name:HEARN, BEVIN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:BEVIN
Middle Name:ELIZABETH
Last Name:HEARN
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:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-355-0607
Mailing Address - Fax:704-302-8004
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR
Practice Address - Street 2:SUITE 300C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2963
Practice Address - Country:US
Practice Address - Phone:704-355-0607
Practice Address - Fax:704-302-8004
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00577207RI0200X
MA240199207R00000X
NY263825207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2014-00577OtherNC LICENSE
SCNC2148Medicaid
NC1770719015Medicaid
NC1770719015Medicaid
SCNC2148Medicaid