Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | C0004855 | MD |
NPI | 1457604944 |
---|---|
Provider Name | Justin Colin Everson |
First Address | Perry Point, MD 21902 |
Second Address | Perry Point, MD 21902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2012 |
Last Update Date | 19/04/2018 |