Provider Demographics
NPI:1790893071
Name:O'NEIL, TERRENCE JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:JAY
Last Name:O'NEIL
Suffix:
Gender:M
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:P.O. BOX 4000
Mailing Address - Street 2:MAIL STOP 11A; ACOS/AMBCARE
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3522
Practice Address - Street 1:JAMES QUILLEN VA MEDICAL CENTER
Practice Address - Street 2:SIDNEY & LAMONT ST'S- BOX 4000 - MAIL STOP CODE 11A
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology