Provider Demographics
NPI:1033445713
Name:SUZANNE M. EVERHART, D.O., P.C.
Entity Type:Organization
Organization Name:SUZANNE M. EVERHART, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVERHART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:804-752-7508
Mailing Address - Street 1:204 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2049
Mailing Address - Country:US
Mailing Address - Phone:804-752-7508
Mailing Address - Fax:804-798-6876
Practice Address - Street 1:204 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2049
Practice Address - Country:US
Practice Address - Phone:804-752-7508
Practice Address - Fax:804-798-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037079207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6301495Medicaid
VAF21398Medicare UPIN
VA180000510Medicare PIN