Provider Demographics
NPI:1467438432
Name:TERLECKY, WASYL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WASYL
Middle Name:
Last Name:TERLECKY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-434-7353
Mailing Address - Fax:937-438-6569
Practice Address - Street 1:1989 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3859
Practice Address - Country:US
Practice Address - Phone:937-434-7353
Practice Address - Fax:937-438-6569
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120344OtherUNITED HEALTH CARE
OH000000227873OtherANTHEM
OH0480251Medicaid
OH080191712OtherRAILROAD MEDICARE
OH34002992OtherMEDICAL LICENSE
OH421534506088OtherCARESOURCE
OHD0299205OtherHUMANA/CHOICECARE
OHOC07198OtherNATIONWIDE
OH000000227873OtherUNICARE
OH2220925OtherAETNA
OH0480251Medicaid
OHTE0493069Medicare PIN