MEDICARE: LARRY S EVERHART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	OH36113	OH

General Provider Information

NPI Number	:	1144275181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY S EVERHART MD

Provider Business Mailing Address
First Line	:	730 MOUNT AIRYSHIRE BLVD
Second Line	:	A
City	:	COLUMBUS
State	:	OH
Zip	:	43235-1328
Country	:	US
Telephone Number	:	614-848-2600
Fax Number	:	614-888-3938

Provider Business Practice Location Address
First Line	:	730 MOUNT AIRYSHIRE BLVD
Second Line	:	A
City	:	COLUMBUS
State	:	OH
Zip	:	43235-1328
Country	:	US
Telephone Number	:	614-848-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	10/23/2007

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