Provider Demographics
NPI:1538134549
Name:OSTERKAMP, TERRE L (MD)
Entity Type:Individual
Prefix:MRS
First Name:TERRE
Middle Name:L
Last Name:OSTERKAMP
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 1:1809 VERDUGO BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1476
Mailing Address - Country:US
Mailing Address - Phone:818-790-8121
Mailing Address - Fax:818-952-0926
Practice Address - Street 1:1809 VERDUGO BLVD
Practice Address - Street 2:350
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-8121
Practice Address - Fax:818-952-0926
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40344207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE92126Medicare UPIN
CAW4264Medicare ID - Type Unspecified