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NPI Code Detail

MEDICARE: LUKE E TERRY JR. MD

MEDICARE:   LUKE E TERRY JR. 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
1207R00000XInternal Medicine PhysicianD0015144MD

Other Identifiers

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

General Provider Information

NPI Number : 1396704557
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKE E TERRY JR. MD
Provider Business Mailing Address
First Line : 8700 CENTRAL AVE, STE 204
Second Line : INTEGRATED MEDICAL CENTER, LLC
City : HYATTSVILLE
State : MD
Zip : 20785
Country : US
Telephone Number : 301-333-3770
Fax Number : 301-333-3779
Provider Business Practice Location Address
First Line : 8700 CENTRAL AVE STE 204
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-4868
Country : US
Telephone Number : 301-333-3770
Fax Number : 301-333-3779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 07/28/2014

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