Provider Demographics
NPI:1366452278
Name:TERRANOVA, LORETTA (MD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:TERRANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 AMITY ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6004
Mailing Address - Country:US
Mailing Address - Phone:718-780-1948
Mailing Address - Fax:718-780-4639
Practice Address - Street 1:97 AMITY ST FL 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6004
Practice Address - Country:US
Practice Address - Phone:718-780-1948
Practice Address - Fax:718-780-4639
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1918625Medicaid
NYE76269Medicare UPIN
NY1918625Medicaid