Provider Demographics
NPI:1740205624
Name:RAMOS, TERRY L (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:RAMOS
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 1:434 TOLLAND TPKE
Mailing Address - Street 2:
Mailing Address - City:WILLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06279-1520
Mailing Address - Country:US
Mailing Address - Phone:860-684-5015
Mailing Address - Fax:860-684-3749
Practice Address - Street 1:434 TOLLAND TPKE
Practice Address - Street 2:
Practice Address - City:WILLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06279-1520
Practice Address - Country:US
Practice Address - Phone:860-684-5015
Practice Address - Fax:860-684-3749
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001376806Medicaid
CTG97095Medicare UPIN