Provider Demographics
NPI:1043210917
Name:TERRIS, ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:TERRIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SILVERSIDE RD
Mailing Address - Street 2:STE 3B
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-1694
Mailing Address - Fax:302-478-1696
Practice Address - Street 1:2700 SILVERSIDE RD STE 3B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3724
Practice Address - Country:US
Practice Address - Phone:302-478-1694
Practice Address - Fax:302-478-1696
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000086213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000042617Medicaid
DE0000600450Medicaid
DE1043210917OtherNPI
DE0000042617Medicaid
DE000750Medicare ID - Type UnspecifiedGROUP NUMBER
DE0000042617Medicaid