Provider Demographics
NPI:1811052087
Name:PFISTER, BEVERLY J (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:J
Last Name:PFISTER
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:4315 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3061
Practice Address - Country:US
Practice Address - Phone:703-293-2452
Practice Address - Fax:703-934-5034
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06041Medicare UPIN
VA007134K32Medicare ID - Type Unspecified
592505M92Medicare ID - Type Unspecified