Provider Demographics
NPI:1649233784
Name:PHILBIN, TERENCE JAMES (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:JAMES
Last Name:PHILBIN
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 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:125-312-9024
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:92 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:CRAFTON
Practice Address - State:PA
Practice Address - Zip Code:15205-3150
Practice Address - Country:US
Practice Address - Phone:412-922-2111
Practice Address - Fax:412-922-7109
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032962E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011291800003Medicaid
PAPH420262Medicare ID - Type Unspecified
PA0011291800003Medicaid