Healthcare Provider Details

I. General information

NPI: 1538141080
Provider Name (Legal Business Name): DAMIAN LEE TERNULLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 INSTITUTE ST
JAMESTOWN NY
14701-6628
US

IV. Provider business mailing address

107 INSTITUTE ST # NA
JAMESTOWN NY
14701-6628
US

V. Phone/Fax

Practice location:
  • Phone: 716-484-4334
  • Fax:
Mailing address:
  • Phone: 716-484-4334
  • Fax: 716-484-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD431647
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number319849
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: