Provider Demographics
NPI:1609874148
Name:TEREFENKO, KEVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:TEREFENKO
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 1:2758 CENTURY BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3358
Mailing Address - Country:US
Mailing Address - Phone:610-376-5646
Mailing Address - Fax:610-376-8546
Practice Address - Street 1:2758 CENTURY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3358
Practice Address - Country:US
Practice Address - Phone:610-376-5646
Practice Address - Fax:610-376-8546
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073496L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA047270Medicare ID - Type Unspecified
PAH18589Medicare UPIN