Provider Demographics
NPI:1467428821
Name:BELDEN, TERRY A (MD)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:A
Last Name:BELDEN
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:PO BOX 7081
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0006
Mailing Address - Country:US
Mailing Address - Phone:843-902-0172
Mailing Address - Fax:843-449-2333
Practice Address - Street 1:2136 BEAR GRASS ROAD WEST
Practice Address - Street 2:
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-8048
Practice Address - Country:US
Practice Address - Phone:843-902-0172
Practice Address - Fax:843-449-2333
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC136604Medicaid
SC136604Medicaid
SCE112373921Medicare PIN
SCE112370281Medicare PIN