Healthcare Provider Details

I. General information

NPI: 1235119116
Provider Name (Legal Business Name): TERRY L ROLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 WHITE HORSE RD SUITE C103
VOORHEES NJ
08043-2461
US

IV. Provider business mailing address

2703 LEEDS AVE
NORTHFIELD NJ
08225-1455
US

V. Phone/Fax

Practice location:
  • Phone: 856-627-1900
  • Fax: 856-627-6907
Mailing address:
  • Phone: 609-484-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA07382600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: