Provider Demographics
NPI:1578859021
Name:NELSON A TERZIAN MD PA
Entity Type:Organization
Organization Name:NELSON A TERZIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-853-7165
Mailing Address - Street 1:P.O. BOX 2668
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037
Mailing Address - Country:US
Mailing Address - Phone:305-853-7165
Mailing Address - Fax:
Practice Address - Street 1:91550 OVERSEAS HWY
Practice Address - Street 2:SUITE #104
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2506
Practice Address - Country:US
Practice Address - Phone:305-853-7165
Practice Address - Fax:305-853-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 47431208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD69020Medicare UPIN