Healthcare Provider Details

I. General information

NPI: 1720265846
Provider Name (Legal Business Name): MATTHEW G. TERRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 3700
DENVER CO
80218-1216
US

IV. Provider business mailing address

1601 E 19TH AVE STE 3700
DENVER CO
80218-1216
US

V. Phone/Fax

Practice location:
  • Phone: 303-831-4774
  • Fax: 303-839-7750
Mailing address:
  • Phone: 303-831-4774
  • Fax: 303-839-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberDR0036795
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: