Healthcare Provider Details

I. General information

NPI: 1043210917
Provider Name (Legal Business Name): ALEXANDER TERRIS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SILVERSIDE RD STE 3B
WILMINGTON DE
19810-3724
US

IV. Provider business mailing address

2700 SILVERSIDE RD STE 3B
WILMINGTON DE
19810-3719
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-1694
  • Fax: 302-478-1696
Mailing address:
  • Phone: 302-478-1694
  • Fax: 302-478-1696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE10000086
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: