Healthcare Provider Details

I. General information

NPI: 1467438432
Provider Name (Legal Business Name): WASYL TERLECKY JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MIAMISBURG CENTERVILLE RD SUITE 301
CENTERVILLE OH
45459-3859
US

IV. Provider business mailing address

2912 SPRINGBORO W SUITE 201
DAYTON OH
45439-1674
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-7353
  • Fax: 937-438-6569
Mailing address:
  • Phone: 937-434-7353
  • Fax: 937-438-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34002992
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: