Provider Demographics
NPI:1508935198
Name:TEREZAKIS, NIA K (MD)
Entity Type:Individual
Prefix:DR
First Name:NIA
Middle Name:K
Last Name:TEREZAKIS
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 1:3800 HOUMA BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4182
Mailing Address - Country:US
Mailing Address - Phone:504-454-2997
Mailing Address - Fax:
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4182
Practice Address - Country:US
Practice Address - Phone:504-454-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010404207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1120421Medicaid
LAB65707Medicare UPIN
LA55302Medicare ID - Type Unspecified