Provider Demographics
NPI:1235247081
Name:A TERRELONGE MD PA
Entity Type:Organization
Organization Name:A TERRELONGE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRELONGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-266-7258
Mailing Address - Street 1:300 NW 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1166
Mailing Address - Country:US
Mailing Address - Phone:786-234-8978
Mailing Address - Fax:305-266-7260
Practice Address - Street 1:7801 CORAL WAY
Practice Address - Street 2:SUITE 131
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6538
Practice Address - Country:US
Practice Address - Phone:305-266-7258
Practice Address - Fax:305-266-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9409Medicare PIN