Provider Demographics
NPI:1184652919
Name:TERRY, CHARLES VADEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:VADEN
Last Name:TERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10410 RIDGEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3544
Mailing Address - Country:US
Mailing Address - Phone:804-754-3776
Mailing Address - Fax:804-754-0880
Practice Address - Street 1:10410 RIDGEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-3544
Practice Address - Country:US
Practice Address - Phone:804-754-3776
Practice Address - Fax:804-754-0880
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010394662080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101039466OtherLICENSE TO PRACTICE
VA0101039466OtherLICENSE TO PRACTICE