MEDICARE: MRS. SHARON MAXINE TERRY

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	156FX1800X	Optician		MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295047595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON MAXINE TERRY

Provider Business Mailing Address
First Line	:	8635 CHERRY LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-6200
Country	:	US
Telephone Number	:	301-483-3103
Fax Number	:	301-483-3105

Provider Business Practice Location Address
First Line	:	8635 CHERRY LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-6200
Country	:	US
Telephone Number	:	301-483-3103
Fax Number	:	301-483-3105

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/02/2010

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