Provider Demographics
NPI:1720026644
Name:PRYOR, TERRI L (PA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:PRYOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16706 NATIONAL HWY SW
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-3304
Mailing Address - Country:US
Mailing Address - Phone:301-689-5415
Mailing Address - Fax:
Practice Address - Street 1:17204 MCMULLEN HWY SW
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6214
Practice Address - Country:US
Practice Address - Phone:301-729-0060
Practice Address - Fax:301-729-3100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003076363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical