Provider Demographics
NPI:1346296258
Name:DOORLY, TERENCE PETER (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:PETER
Last Name:DOORLY
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 1:4 CENTENNIAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7935
Mailing Address - Country:US
Mailing Address - Phone:979-977-3500
Mailing Address - Fax:978-977-0905
Practice Address - Street 1:4 CENTENNIAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7935
Practice Address - Country:US
Practice Address - Phone:979-977-3500
Practice Address - Fax:978-977-0905
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76704207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3103587Medicaid
E19631Medicare UPIN
MA3103587Medicaid