Provider Demographics
NPI:1982600201
Name:BEARD, DAVID CRAVEN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CRAVEN
Last Name:BEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-343-9800
Mailing Address - Fax:704-347-2011
Practice Address - Street 1:125 QUEENS RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3215
Practice Address - Country:US
Practice Address - Phone:704-343-9800
Practice Address - Fax:704-347-2011
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31768207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982600201Medicaid
285735OtherMAMSI
SCQ31769Medicaid
NC14153OtherBLUE CROSS BLUE SHIELD
2790OtherAETNA
NC8914153Medicaid
13898OtherPARTNERS
NC8914153Medicaid
13898OtherPARTNERS
2790OtherAETNA
C82750Medicare UPIN
NCNCO375AMedicare PIN
SCQ31769Medicaid