Healthcare Provider Details

I. General information

NPI: 1174937395
Provider Name (Legal Business Name): DANIEL EVERING JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLD FERN HILL RD STE 1
WEST CHESTER PA
19380-4269
US

IV. Provider business mailing address

4 EVES DR STE A100
MARLTON NJ
08053-3126
US

V. Phone/Fax

Practice location:
  • Phone: 610-692-6280
  • Fax:
Mailing address:
  • Phone: 609-267-9400
  • Fax: 609-267-9457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MB10327900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS018891
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: