Healthcare Provider Details

I. General information

NPI: 1538546585
Provider Name (Legal Business Name): MARY JEANNE TERRELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY JEANNE LUSKEY M.D.

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNC DEPARTMENT OF PEDIATRICS UNC SOM 260 MACNIDER BUILDING, CB#7220
CHAPEL HILL NC
27599-7220
US

IV. Provider business mailing address

UNC DEPARTMENT OF PEDIATRICS UNC SOM 260 MACNIDER BUILDING, CB#7220
CHAPEL HILL NC
27599-7220
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-1505
  • Fax: 919-966-7299
Mailing address:
  • Phone: 919-966-1505
  • Fax: 919-966-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2018-00285
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: