Healthcare Provider Details

I. General information

NPI: 1962499103
Provider Name (Legal Business Name): TERRENCE XAVIER DWYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8926 WOODYARD RD SUITE 602
CLINTON MD
20735-4220
US

IV. Provider business mailing address

8926 WOODYARD RD SUITE 701
CLINTON MD
20735-4220
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-1682
  • Fax: 301-856-8214
Mailing address:
  • Phone: 301-856-1682
  • Fax: 301-856-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD36294
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: