Healthcare Provider Details

I. General information

NPI: 1144275181
Provider Name (Legal Business Name): LARRY S EVERHART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MOUNT AIRYSHIRE BLVD A
COLUMBUS OH
43235-1328
US

IV. Provider business mailing address

730 MOUNT AIRYSHIRE BLVD A
COLUMBUS OH
43235-1328
US

V. Phone/Fax

Practice location:
  • Phone: 614-848-2600
  • Fax:
Mailing address:
  • Phone: 614-848-2600
  • Fax: 614-888-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOH36113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: