Basic Information
Provider Information
NPI: 1003004839
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DARNELL
FirstName: BEVERLY
MiddleName: HAGNER
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: KAISER PERMANENTE MEDICARE ENROLLMENT
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018162424
FaxNumber:  
Practice Location
Address1: 10810 CONNECTICUT AVE
Address2:  
City: KENSINGTON
State: MD
PostalCode: 208952138
CountryCode: US
TelephoneNumber: 3019297100
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/05/2007
LastUpdateDate: 11/14/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD0054072MDY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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