Provider Demographics
NPI:1497774483
Name:TEREBUH, ANNETTE K (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:K
Last Name:TEREBUH
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:PO BOX 190
Mailing Address - Street 2:1107 RUSH AVE
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-0190
Mailing Address - Country:US
Mailing Address - Phone:937-593-3881
Mailing Address - Fax:937-593-2430
Practice Address - Street 1:1107 RUSH AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9488
Practice Address - Country:US
Practice Address - Phone:937-593-3881
Practice Address - Fax:937-593-2430
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH7256OtherECPA PIN
OHP00118537OtherRR PIN
OH4393131OtherAETNA PIN
OH2216471Medicaid
OH000000065900OtherANTHEM PIN
0872771OtherMEDICARE LEGACY NUMBER
OHP00118537OtherRR PIN