Healthcare Provider Details

I. General information

NPI: 1174773923
Provider Name (Legal Business Name): ANDREA L TERRY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NEUSE BLVD # C
NEW BERN NC
28560-3449
US

IV. Provider business mailing address

PO BOX 896206
CHARLOTTE NC
28289-6206
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-8024
  • Fax: 252-633-8994
Mailing address:
  • Phone: 252-633-8024
  • Fax: 252-633-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberNC2010-00478
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: