Provider Demographics
NPI:1437126752
Name:EVERETT, AMY V (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:V
Last Name:EVERETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:CREDENTIALS DEPTS
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:425 E 1ST ST
Practice Address - Street 2:STE 201
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1480
Practice Address - Country:US
Practice Address - Phone:570-416-1816
Practice Address - Fax:570-416-1810
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2020-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010275L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018509870007Medicaid
PA0018509870007Medicaid
PAEV050519Medicare PIN