Provider Demographics
NPI:1366638173
Name:HETRICK-PLATTE, TERA NIKOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERA
Middle Name:NIKOLE
Last Name:HETRICK-PLATTE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3700
Practice Address - Street 1:35 EMPIRE STATE BLVD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9777
Practice Address - Country:US
Practice Address - Phone:518-477-2167
Practice Address - Fax:518-477-5182
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2016-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY245727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02928509Medicaid
NYJ400003656Medicare PIN