Provider Demographics
NPI:1023073889
Name:BEWLEY, MARK ANDREW (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:BEWLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:230 CLEARFIELD AVENUE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:VABEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-321-3383
Mailing Address - Fax:757-321-3332
Practice Address - Street 1:6160 KEMPSVILLE CIR
Practice Address - Street 2:SUITE 200B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3933
Practice Address - Country:US
Practice Address - Phone:757-321-3300
Practice Address - Fax:757-321-3332
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-02-04
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Provider Licenses
StateLicense IDTaxonomies
VA0101232432207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6408796Medicaid
VA6408796Medicaid
VA200001183Medicare PIN