Provider Demographics
NPI:1053449934
Name:BISSELL, TERRY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ANN
Last Name:BISSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1632
Mailing Address - Country:US
Mailing Address - Phone:626-403-8999
Mailing Address - Fax:626-403-8989
Practice Address - Street 1:2400 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1632
Practice Address - Country:US
Practice Address - Phone:626-403-8999
Practice Address - Fax:626-403-8989
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG615892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE04672Medicare UPIN
CAWCG1589BMedicare PIN