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General NPI Number Information
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NPI Number | 1447429980
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Entity Type | Individual
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Provider Name | ROBERT TERAILA D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 190 MARKET SQ REAR
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City | NEWINGTON
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State | CT
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Zip | 06111-2913
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Country | US
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Telephone | 860-666-7939
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Fax | 860-666-7897
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Provider Business Mailing Address
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Address Line | 190 MARKET SQ REAR
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City | NEWINGTON
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State | CT
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Zip | 06111-2913
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Country | US
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Telephone | 860-666-7939
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Fax | 860-666-7897
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POO363
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License Number State | CT
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