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General NPI Number Information
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NPI Number | 1982613303
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Entity Type | Individual
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Provider Name | JODY LYNN TERRANOVA DO
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 131 COVENTRY ST 2ND FLOOR
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City | HARTFORD
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State | CT
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Zip | 06112-1548
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Country | US
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Telephone | 860-714-3690
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Fax | 860-714-8683
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Provider Business Mailing Address
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Address Line | 131 COVENTRY STREET 2ND FLOOR
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City | HARTFORD
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State | CT
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Zip | 06032-2573
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Country | US
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Telephone | 860-714-3690
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Fax | 860-714-8683
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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 | 044324
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License Number State | CT
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