Provider Demographics
NPI:1326013525
Name:DEVINE, TERENCE MOODY (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:MOODY
Last Name:DEVINE
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-3236
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131307-1207W00000X
PAMD028357E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00627770Medicaid
PACC9269OtherRR MEDICARE GROUP
NYP00258515OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
PA00009003960001Medicaid
PAGU039847OtherMEDICARE GROUP
PA180040307OtherRR MEDICARE PIN
PA180040307OtherRR MEDICARE PIN
NYP00258515OtherRR MEDICARE PIN
NY52021BMedicare ID - Type Unspecified