Provider Demographics
NPI:1588675888
Name:TERRY, ROBERT COOPER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:COOPER
Last Name:TERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 2310
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6810
Mailing Address - Country:US
Mailing Address - Phone:803-648-1318
Mailing Address - Fax:803-226-0111
Practice Address - Street 1:410 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 2310
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6810
Practice Address - Country:US
Practice Address - Phone:803-648-1318
Practice Address - Fax:803-226-0111
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC7982208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC86733Medicare UPIN
SCC867335195Medicare PIN