Provider Demographics
NPI:1033290606
Name:TERRELS, MARY ELLEN J (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:J
Last Name:TERRELS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 CINCINNATI AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-1926
Practice Address - Country:US
Practice Address - Phone:609-965-2091
Practice Address - Fax:609-965-1585
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB46954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54099Medicare UPIN
521782Medicare ID - Type Unspecified
NJ521782SBVMedicare PIN