Provider Demographics
NPI:1407807431
Name:BEVERIDGE, CLAY E (MD)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:E
Last Name:BEVERIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4510
Mailing Address - Country:US
Mailing Address - Phone:804-228-3627
Mailing Address - Fax:804-560-1312
Practice Address - Street 1:229 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4510
Practice Address - Country:US
Practice Address - Phone:804-228-3627
Practice Address - Fax:804-560-1312
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00309631OtherRAILROAD MEDICARE
VA010252083Medicaid
VA010252091Medicaid
VA010252083Medicaid
VA010252091Medicaid
VAP00309631OtherRAILROAD MEDICARE