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General NPI Number Information
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NPI Number | 1750586780
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Entity Type | Organization
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Legal Business Name | TERIBURY MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 114 DESMOND ST
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City | SAYRE
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State | PA
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Zip | 18840-2084
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Country | US
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Telephone | 570-882-7401
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Fax | 570-882-7404
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Provider Business Mailing Address
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Address Line | 114 DESMOND ST
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City | SAYRE
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State | PA
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Zip | 18840-2084
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Country | US
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Telephone | 570-882-7401
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Fax | 570-882-7404
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Authorized Official
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Title or Position | OWNER
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Name | DR. FREDERICK L TERIBURY JR.
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Credential | M.D.
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Telephone | 570-882-7401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD427223
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License Number State | PA
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