Provider Demographics
NPI:1982792610
Name:HENSON-EVERSON, CHERYL L (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:HENSON-EVERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 VARNUM ST NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2151
Mailing Address - Country:US
Mailing Address - Phone:202-832-2890
Mailing Address - Fax:202-529-5720
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:SUITE 105
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-832-2890
Practice Address - Fax:202-529-5720
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE27288Medicare UPIN
DCHE574262Medicare ID - Type Unspecified