Provider Demographics
NPI:1336142504
Name:TERKELSEN, KENNETH GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GEORGE
Last Name:TERKELSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:319 CAIRN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-7928
Mailing Address - Country:US
Mailing Address - Phone:508-737-6208
Mailing Address - Fax:815-366-8186
Practice Address - Street 1:107 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6507
Practice Address - Country:US
Practice Address - Phone:508-477-7090
Practice Address - Fax:508-477-7028
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1603652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2113121Medicaid
TE A29895Medicare ID - Type UnspecifiedMCR NHIC PROV ID
B16657Medicare UPIN