Healthcare Provider Details

I. General information

NPI: 1346273844
Provider Name (Legal Business Name): TERRY OVERHOLSER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 E STATE RD
NEWCOMERSTOWN OH
43832-9063
US

IV. Provider business mailing address

PO BOX 57
WEST LAFAYETTE OH
43845-0057
US

V. Phone/Fax

Practice location:
  • Phone: 740-498-5515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34002235
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: