Provider Demographics
NPI:1003996349
Name:TERLONGE, DELOUIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DELOUIS
Middle Name:
Last Name:TERLONGE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 COMPUTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6506
Mailing Address - Country:US
Mailing Address - Phone:919-782-5273
Mailing Address - Fax:919-232-5551
Practice Address - Street 1:3801 COMPUTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6506
Practice Address - Country:US
Practice Address - Phone:919-782-5273
Practice Address - Fax:919-232-5551
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7214208000000X
NC2008-00653208000000X
FLME0089059208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163939501Medicaid
TX163939501Medicaid
8B5573Medicare ID - Type Unspecified