Provider Demographics
NPI:1861780017
Name:BEVERIDGE, MARA (MD)
Entity type:Individual
Prefix:DR
First Name:MARA
Middle Name:
Last Name:BEVERIDGE
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 1:3000 AUBURN DR STE 125
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4343
Mailing Address - Country:US
Mailing Address - Phone:216-514-8630
Mailing Address - Fax:216-514-8290
Practice Address - Street 1:11100 EUCLID AVE FL 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-8200
Practice Address - Fax:216-514-8290
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137378207N00000X
OH35.133902207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology