Provider Demographics
NPI:1467668145
Name:TERRANELLA, ANDREW JAMES (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:TERRANELLA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20963 SPANISH GRANT DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9500
Mailing Address - Country:US
Mailing Address - Phone:989-528-0795
Mailing Address - Fax:
Practice Address - Street 1:20963 SPANISH GRANT DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9500
Practice Address - Country:US
Practice Address - Phone:989-528-0795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36965208000000X
CAC140785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060012Medicaid
AZHSZ045Medicare PIN
AZ060012Medicaid