Healthcare Provider Details

I. General information

NPI: 1619963337
Provider Name (Legal Business Name): JOHN K TERZIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W CENTER ST SUITE 2100
WEST BRIDGEWATER MA
02379-1542
US

IV. Provider business mailing address

711 W CENTER ST SUITE 2100
WEST BRIDGEWATER MA
02379-1542
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-1100
  • Fax: 508-583-1120
Mailing address:
  • Phone: 508-583-1100
  • Fax: 508-583-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number52785
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: