Provider Demographics
NPI:1619088507
Name:MOWATT, TERRYE ANN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRYE
Middle Name:ANN MARIE
Last Name:MOWATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6304 EARLY GLOW CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4498
Mailing Address - Country:US
Mailing Address - Phone:410-381-0600
Mailing Address - Fax:410-381-0090
Practice Address - Street 1:10808 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-381-0060
Practice Address - Fax:410-381-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00538952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBM752192OtherCDS LICENSE
MDBM752192OtherCDS LICENSE
MD208996258OtherTIN OTHER OFFICE
MDKR98M436Medicare ID - Type UnspecifiedPROVIDER NUMBER
MD52-1885475OtherEIN