Healthcare Provider Details

I. General information

NPI: 1386671683
Provider Name (Legal Business Name): MISHKA S. TERPLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PARK AVE STE 103
BALTIMORE MD
21201-5633
US

IV. Provider business mailing address

1040 PARK AVE STE 103
BALTIMORE MD
21201-5633
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-3977
  • Fax:
Mailing address:
  • Phone: 410-837-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101261470
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberD0069726
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: