Provider Demographics
NPI:1477048536
Name:TERRY, BRANDON WELLINGTON (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:WELLINGTON
Last Name:TERRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DEFENSE HWY STE 501
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7063
Mailing Address - Country:US
Mailing Address - Phone:888-820-3376
Mailing Address - Fax:888-826-4576
Practice Address - Street 1:116 DEFENSE HWY STE 501
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7063
Practice Address - Country:US
Practice Address - Phone:888-820-3376
Practice Address - Fax:888-826-4576
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant