Provider Demographics
NPI:1073551073
Name:TERWILLIGER, JEFFREY MATTHEW (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:TERWILLIGER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-568-3774
Mailing Address - Fax:508-775-2352
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-496-6820
Practice Address - Fax:413-496-6821
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1072755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant