Provider Demographics
NPI:1932172236
Name:MYERS, BEVERLY A (MD)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:A
Last Name:MYERS
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 1:1087 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888
Mailing Address - Country:US
Mailing Address - Phone:401-461-5367
Mailing Address - Fax:401-461-3165
Practice Address - Street 1:1087 WARWICK AV
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888
Practice Address - Country:US
Practice Address - Phone:401-461-5367
Practice Address - Fax:401-461-3165
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI55802084P0804X
MA582642084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1554968OtherUNITED HEALTH
RI1022550OtherBEACON
RI9020065Medicaid
022432OtherVALUE OPTIONS
RI1022550OtherNEIGHBORHOOD HEALTH PLAN
RI200659OtherBLUE CROSS
C90264Medicare UPIN