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General NPI Number Information
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NPI Number | 1366705675
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Entity Type | Individual
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Provider Name | TERRY DEAN JR. MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 111 MICHIGAN AVE NW # M7746C
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City | WASHINGTON
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State | DC
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Zip | 20010-2916
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Country | US
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Telephone | 202-476-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 111 MICHIGAN AVE NW # M7746C
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City | WASHINGTON
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State | DC
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Zip | 20010-2916
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Country | US
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Telephone | 856-776-3322
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT201048
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | MD047426
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License Number State | DC
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