Provider Demographics
NPI:1033167945
Name:BYRD, BEVERLY A (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:BYRD
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 1:128 N EDGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2936
Mailing Address - Country:US
Mailing Address - Phone:860-614-1549
Mailing Address - Fax:
Practice Address - Street 1:180 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2430
Practice Address - Country:US
Practice Address - Phone:336-527-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01649207V00000X
NH18058207V00000X
CT039292207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
412113050OtherUNITED HEALTHCARE
00139292702OtherBLUDE CARE FAMILY PLAN
230491OtherPREFERRED ONE
039292OtherCONNECTICARE
P3074366OtherOXFORD
2V4200OtherHEALTHNET
010039292CT04OtherANTHEM
3390202OtherAETNA
4121133150OtherCIGNA