Provider Demographics
NPI:1144275181
Name:EVERHART, LARRY S (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:S
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 1:730 MOUNT AIRYSHIRE BLVD
Mailing Address - Street 2:A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1328
Mailing Address - Country:US
Mailing Address - Phone:614-848-2600
Mailing Address - Fax:614-888-3938
Practice Address - Street 1:730 MOUNT AIRYSHIRE BLVD
Practice Address - Street 2:A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1328
Practice Address - Country:US
Practice Address - Phone:614-848-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH36113207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A75554Medicare UPIN
OH0421336Medicare PIN