Provider Demographics
NPI:1447429980
Name:TERAILA, ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:TERAILA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MARKET SQ REAR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2913
Mailing Address - Country:US
Mailing Address - Phone:860-666-7939
Mailing Address - Fax:860-666-7897
Practice Address - Street 1:190 MARKET SQ REAR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2913
Practice Address - Country:US
Practice Address - Phone:860-666-7939
Practice Address - Fax:860-666-7897
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPOO363213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22838Medicare UPIN