Provider Demographics
NPI:1649442005
Name:MARY ANN EVERHART-MCDONALD TT, EVERHART-MCDONALD PHYSICAL MEDICINE
Entity type:Organization
Organization Name:MARY ANN EVERHART-MCDONALD TT, EVERHART-MCDONALD PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-840-9200
Mailing Address - Street 1:1121 NORTHVIEW DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-6316
Mailing Address - Country:US
Mailing Address - Phone:937-840-9200
Mailing Address - Fax:937-840-9205
Practice Address - Street 1:1121 NORTHVIEW DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-6316
Practice Address - Country:US
Practice Address - Phone:937-840-9200
Practice Address - Fax:937-840-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.052171225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0905873Medicaid
OH9254321Medicare PIN