Provider Demographics
NPI:1114120722
Name:WASHINGTON, TERRI (M D)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 BROADWAY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-2040
Mailing Address - Country:US
Mailing Address - Phone:708-345-2211
Mailing Address - Fax:708-345-2224
Practice Address - Street 1:1835 BROADWAY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2040
Practice Address - Country:US
Practice Address - Phone:708-345-2211
Practice Address - Fax:708-345-2224
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118965207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism