Provider Demographics
NPI:1205861226
Name:DELANEY, TERENCE J (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:J
Last Name:DELANEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14911 NATIONAL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2632
Mailing Address - Country:US
Mailing Address - Phone:408-402-5742
Mailing Address - Fax:408-358-2089
Practice Address - Street 1:14911 NATIONAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2632
Practice Address - Country:US
Practice Address - Phone:408-402-5742
Practice Address - Fax:408-358-2089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG073592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG073592OtherSTATE LICENSE
CAF39099Medicare UPIN
CAG073592OtherSTATE LICENSE