Provider Demographics
NPI:1649223561
Name:TERKONDA, ANNU A (MD)
Entity Type:Individual
Prefix:
First Name:ANNU
Middle Name:A
Last Name:TERKONDA
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 1:10777 SUNSET OFFICE DR
Mailing Address - Street 2:STE. 310
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1019
Mailing Address - Country:US
Mailing Address - Phone:314-822-5900
Mailing Address - Fax:314-822-5919
Practice Address - Street 1:3555 SUNSET OFFICE DR
Practice Address - Street 2:STE. C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1015
Practice Address - Country:US
Practice Address - Phone:314-238-9100
Practice Address - Fax:314-238-9110
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105686207PE0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSH51584OtherUPIN NUMBER
MO119050166Medicare PIN
MO991373009Medicare PIN