MEDICARE: WILLIAM A TERRANOVA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	13072	SC

General Provider Information

NPI Number	:	1154395200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM A TERRANOVA MD

Provider Business Mailing Address
First Line	:	2683 LAKE PARK DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9100
Country	:	US
Telephone Number	:	843-797-0440
Fax Number	:	843-553-6071

Provider Business Practice Location Address
First Line	:	2683 LAKE PARK DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9100
Country	:	US
Telephone Number	:	843-797-0440
Fax Number	:	843-553-6071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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