Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 0101057835 | VA |
Y | 207QA0505X | Family Doctor - Adult Medicine | 9800784 | NC |
NPI | 1295715704 |
---|---|
Provider Name | Dr. Mary-Emma Beres |
First Address | Elkin, NC 28621-2482 |
Second Address | Elkin, NC 28621-2482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005610681 | (05) | VA |
690573G | (05) | VA |
G82117 | (02) |