Provider Demographics
NPI:1265488001
Name:ROBERT Q TERRILL MD PC
Entity Type:Organization
Organization Name:ROBERT Q TERRILL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-363-6446
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUITE 685
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1200
Mailing Address - Country:US
Mailing Address - Phone:508-363-6446
Mailing Address - Fax:
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 685
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1200
Practice Address - Country:US
Practice Address - Phone:508-363-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72507174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9730320Medicaid
MA9730320Medicaid
M21320Medicare PIN