Provider Demographics
NPI:1619055936
Name:TERREBONNE, MAE ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAE ELLEN
Middle Name:
Last Name:TERREBONNE
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 1:18314 GENERAL PULLER HWY
Mailing Address - Street 2:
Mailing Address - City:DELTAVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23043-2029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2221 EDWARD HOLLAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2518
Practice Address - Country:US
Practice Address - Phone:804-354-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics