Provider Demographics
NPI:1942279484
Name:EVERHART, CHARLES W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:EVERHART
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:310 ELECTRIC AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1369
Mailing Address - Country:US
Mailing Address - Phone:717-242-2531
Mailing Address - Fax:717-242-1028
Practice Address - Street 1:310 ELECTRIC AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1369
Practice Address - Country:US
Practice Address - Phone:717-242-2531
Practice Address - Fax:717-242-1028
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019992E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01412701OtherCAPITAL BLUE CROSS
PA0915290Medicaid
PA28124OtherGEISINGER HEALTH PLAN
PA028663Medicare ID - Type Unspecified
PAC27898Medicare UPIN