=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457574741
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DESPINA TERRIS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 06/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 HAMILTON AVE ST. FRANCIS MEDICAL CENTER - RADIATION ONCOLOGY DEPT.
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08629-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-599-5179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 HAMILTON AVENUE ST. FRANCIS MEDICAL CENTER - RADIATION ONCOLOGY DEPT.
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08629-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-599-5179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | MD039786L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 25MA04949100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------