Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101232432 | VA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101232432 | VA |
NPI | 1023073889 |
---|---|
Provider Name | Mark Andrew Bewley |
First Address | Vabeach, VA 23462 |
Second Address | Norfolk, VA 23502-3933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6408796 | (05) | VA |
H60364 | (02) |