Provider Demographics
NPI:1598768764
Name:HART, EVERETT T (MD)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:T
Last Name:HART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37086
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3086
Mailing Address - Country:US
Mailing Address - Phone:240-439-8812
Mailing Address - Fax:
Practice Address - Street 1:75 THOMAS JOHNSON DR
Practice Address - Street 2:STE B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4895
Practice Address - Country:US
Practice Address - Phone:301-695-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044237207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522122846-003OtherCIGNA
DCB5830001OtherCAREFIRST BLUE CROSS BLUE
MD23965001OtherUNITED HEALTHCARE
MD52801003OtherCAREFIRST BLUE CROSS BLUE
MD649961900Medicaid
DCB5830001OtherCAREFIRST BLUE CROSS BLUE
674L301DMedicare ID - Type Unspecified