Provider Demographics
NPI:1831160399
Name:LEWIS, BEVERLY ANN (MD)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:A
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 884
Mailing Address - Street 2:405 MCCASKEY RD
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892
Mailing Address - Country:US
Mailing Address - Phone:252-792-6071
Mailing Address - Fax:252-792-0889
Practice Address - Street 1:983 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9216
Practice Address - Country:US
Practice Address - Phone:252-793-1010
Practice Address - Fax:252-793-4113
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0185M51791OtherBLUE CROSS
NC8951791Medicaid
NC0185M51791OtherBLUE CROSS
NC8951791Medicaid