Provider Demographics
NPI:1225175557
Name:FLICK, TERISA LYNN FOSTER (MD)
Entity Type:Individual
Prefix:
First Name:TERISA
Middle Name:LYNN FOSTER
Last Name:FLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6906 PINEWAY
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:29782-1162
Mailing Address - Country:US
Mailing Address - Phone:202-412-5357
Mailing Address - Fax:
Practice Address - Street 1:2401 BLUERIDGE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4517
Practice Address - Country:US
Practice Address - Phone:301-933-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics