Provider Demographics
NPI:1093816811
Name:HIMELFARB, TERREN MERRILL (MD)
Entity Type:Individual
Prefix:
First Name:TERREN
Middle Name:MERRILL
Last Name:HIMELFARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 E NORTHERN PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2113
Mailing Address - Country:US
Mailing Address - Phone:410-433-0760
Mailing Address - Fax:410-532-3503
Practice Address - Street 1:1900 E NORTHERN PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2113
Practice Address - Country:US
Practice Address - Phone:410-433-0760
Practice Address - Fax:410-532-3503
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD05414208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD068981501(SOLO #)OtherMEDICAL ASSISTANCE
DCR437-0001OtherCAREFIRST
MD32458402 (RENDERING)OtherCAREFIRST
MDTIN & NPI 1OtherMEDSTAR FAMILY CHOICE
MD203617YDLV (MEMBER)OtherMEDICARE
GAPENDINGOtherRAILROAD MEDICARE