Provider Demographics
NPI:1518076181
Name:EVERHART, SUZANNE M (DO,PC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:EVERHART
Suffix:
Gender:F
Credentials:DO,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037079207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA45783OtherOPTIMA HEALTH
VA006301495Medicaid
VA047741OtherBLUE CROSS BLUE SHILED VA
VA412574OtherALLIANCE,OPTIMUM,MDIPA
VA433600120OtherPRIVATE HEALTHCARE SYSTEM
VA668240OtherAETNA PROVIDER NUMBER
VA668240OtherAETNA PROVIDER NUMBER
VA180000510Medicare ID - Type UnspecifiedPROVIDER NUMBER
VA412574OtherALLIANCE,OPTIMUM,MDIPA
VA180020646Medicare ID - Type UnspecifiedRAILROAD PROVIDER NUMBER