Provider Demographics
NPI:1912903998
Name:BEVILACQUA, ANTHONY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:BEVILACQUA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3843
Mailing Address - Country:US
Mailing Address - Phone:757-547-5145
Mailing Address - Fax:757-312-0216
Practice Address - Street 1:150 BURNETTS WAY
Practice Address - Street 2:STE. 100
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8168
Practice Address - Country:US
Practice Address - Phone:757-547-5145
Practice Address - Fax:757-539-7488
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-02810207X00000X
VA0102037163207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010163005Medicaid
VA007175S88Medicare ID - Type Unspecified
VA010163005Medicaid