Healthcare Provider Details

I. General information

NPI: 1861653404
Provider Name (Legal Business Name): TERRY LEE EVERHART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 BRAVERTON STREET SUITE 201
EDGEWATER MD
21037-2690
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-4911
  • Fax: 410-956-4935
Mailing address:
  • Phone: 443-481-6480
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2010-01890
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number149428
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD72318
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: