Provider Demographics
NPI:1578609012
Name:SCHROEDER, TERRY MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MILTON
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 WILKINS DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7240
Mailing Address - Country:US
Mailing Address - Phone:919-774-6740
Mailing Address - Fax:
Practice Address - Street 1:1725 WILKINS DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-7240
Practice Address - Country:US
Practice Address - Phone:919-774-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22824208600000X, 2086S0127X, 2086S0129X, 2086X0206X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Not Answered2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Not Answered208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974898Medicaid
210235AMedicare ID - Type Unspecified
NC8974898Medicaid