MEDICARE: DAVID THOMAS TERRANO MD, PHD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	54161	AZ
2	207ZD0900X	Dermatopathology (Pathology) Physician	54161	AZ

General Provider Information

NPI Number	:	1609169267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID THOMAS TERRANO MD, PHD

Provider Business Mailing Address
First Line	:	11025 RCA CENTER DR
Second Line	:	STE 300
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4269
Country	:	US
Telephone Number	:	561-383-3820
Fax Number	:

Provider Business Practice Location Address
First Line	:	9060 E VIA LINDA
Second Line	:	SUITE 150
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-5422
Country	:	US
Telephone Number	:	480-275-2494
Fax Number	:	480-772-4296

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

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	04/13/2017

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