Provider Demographics
NPI:1407387582
Name:NG, BEVERLY (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:NG
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 1:509 OLDE WATERFORD WAY STE 305
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4179
Mailing Address - Country:US
Mailing Address - Phone:910-641-8640
Mailing Address - Fax:910-641-8645
Practice Address - Street 1:509 OLDE WATERFORD WAY STE 305
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4179
Practice Address - Country:US
Practice Address - Phone:910-641-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-03416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine