Provider Demographics
NPI:1790909539
Name:LINDA G. EVERETT, MD, PA
Entity Type:Organization
Organization Name:LINDA G. EVERETT, MD, PA
Other - Org Name:EVERETT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-268-5560
Mailing Address - Street 1:1284 GAP NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9503
Mailing Address - Country:US
Mailing Address - Phone:610-268-5560
Mailing Address - Fax:888-557-4504
Practice Address - Street 1:1284 GAP NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-9503
Practice Address - Country:US
Practice Address - Phone:610-268-5560
Practice Address - Fax:888-557-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101393738001Medicaid
PA101393738001Medicaid
088578UH9Medicare PIN
PAH41470Medicare UPIN