Provider Demographics
NPI:1487647673
Name:ROBBINS, TERRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:J
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 PARK LN
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-9679
Mailing Address - Country:US
Mailing Address - Phone:610-767-9454
Mailing Address - Fax:
Practice Address - Street 1:5649 WYNNEWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LAURYS STATION
Practice Address - State:PA
Practice Address - Zip Code:18059-1138
Practice Address - Country:US
Practice Address - Phone:610-261-1115
Practice Address - Fax:610-261-9601
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018156E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C31937Medicare UPIN