Provider Demographics
NPI:1861653404
Name:EVERHART, TERRY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:EVERHART
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 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6480
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:3169 BRAVERTON STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2690
Practice Address - Country:US
Practice Address - Phone:410-956-4911
Practice Address - Fax:410-956-4935
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01890207Q00000X
NC149428207Q00000X
MDD72318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD043456600Medicaid
MD97518901OtherBCBS
DCK6430005OtherBCBS
MD9140763OtherAETNA PPO
MD8082731OtherAETNA HMO
MDP00963504Medicare PIN
MD222082Y5ZMedicare PIN