Provider Demographics
NPI:1770696262
Name:WEDDA, BEVERLY (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:WEDDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 W WOODCROFT PKWY
Mailing Address - Street 2:#6D
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7726
Mailing Address - Country:US
Mailing Address - Phone:508-397-6792
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:DURHAM VA MEDICAL CENTER AMBULATORY CARE
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-416-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA156858207Q00000X
NC2015-01803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA156858OtherTUFTS HEALTH PLAN
MA0106806OtherUNITED HEALTH CARE
MA4180068OtherCIGNA
MA714677OtherHARVARD PILGRIM
MAJ21423OtherBCBS OF MA
MA56020OtherFALLON
MA56020OtherFALLON
MA4180068OtherCIGNA