=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043210917
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER TERRIS D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2005
-----------------------------------------------------
Last Update Date | 05/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 SILVERSIDE RD STE 3B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-3724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-478-1694
-----------------------------------------------------
Fax | 302-478-1696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 SILVERSIDE RD STE 3B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-478-1694
-----------------------------------------------------
Fax | 302-478-1696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | E10000086
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------