Healthcare Provider Details

I. General information

NPI: 1013176924
Provider Name (Legal Business Name): LEKEISHA TERRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 4TH ST SE STE 114 BALLOU STUDENT HEALTH CENTER, UNITY HEALTH CARE
WASHINGTON DC
20032-5406
US

IV. Provider business mailing address

3401 4TH ST SE STE 114 BALLOU STUDENT HEALTH CENTER, UNITY HEALTH CENTER
WASHINGTON DC
20032-5406
US

V. Phone/Fax

Practice location:
  • Phone: 202-645-3843
  • Fax: 202-645-3675
Mailing address:
  • Phone: 202-645-3843
  • Fax: 202-645-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD039670
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: