Provider Demographics
NPI:1871585091
Name:GREGORY, BEVERLY D (PA-C)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:D
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 33RD ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1409
Mailing Address - Country:US
Mailing Address - Phone:202-583-3170
Mailing Address - Fax:
Practice Address - Street 1:5801 ALLENTOWN RD
Practice Address - Street 2:SUITE 502
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4563
Practice Address - Country:US
Practice Address - Phone:240-427-1630
Practice Address - Fax:240-492-2070
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003134363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S98671Medicare UPIN