Provider Demographics
NPI:1831151034
Name:BEAL, EVELYN NTUBE (MD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:NTUBE
Last Name:BEAL
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 1:3363 VILLAGE DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4508
Mailing Address - Country:US
Mailing Address - Phone:910-486-7006
Mailing Address - Fax:910-222-0401
Practice Address - Street 1:3363 VILLAGE DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4508
Practice Address - Country:US
Practice Address - Phone:910-486-7006
Practice Address - Fax:910-222-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000354207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912686Medicaid
NC12628OtherBCBS
NC12628OtherBCBS
H21395Medicare UPIN