Provider Demographics
NPI:1235119116
Name:ROLLINS, TERRY L (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:ROLLINS
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 1:2703 LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1455
Mailing Address - Country:US
Mailing Address - Phone:609-484-8814
Mailing Address - Fax:
Practice Address - Street 1:707 WHITE HORSE RD
Practice Address - Street 2:SUITE C103
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2461
Practice Address - Country:US
Practice Address - Phone:856-627-1900
Practice Address - Fax:856-627-6907
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07382600207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH63365Medicare UPIN
NJ058710NKWMedicare ID - Type Unspecified