Provider Demographics
NPI:1891712360
Name:EBERTS, PAUL MARK (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MARK
Last Name:EBERTS
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 1:839 LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4435
Mailing Address - Country:US
Mailing Address - Phone:610-241-3050
Mailing Address - Fax:610-241-3059
Practice Address - Street 1:839 LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4435
Practice Address - Country:US
Practice Address - Phone:610-241-3050
Practice Address - Fax:610-241-3059
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034105E207RG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0410653000OtherAMERIHEALTH
0000551201OtherDE PHYSICAL CARE
257199OtherMAMSI
510064326OtherAETNA USHC
DE0000551201Medicaid
1937OtherCOVENTRY
A72524OtherBCBS OF DE
510064326OtherAETNA USHC
1937OtherCOVENTRY
0410653000OtherAMERIHEALTH