Provider Demographics
NPI:1851702195
Name:TERRELL, DAVID ANDREW (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:TERRELL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6246
Mailing Address - Country:US
Mailing Address - Phone:802-257-5111
Mailing Address - Fax:802-254-0178
Practice Address - Street 1:238 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6246
Practice Address - Country:US
Practice Address - Phone:802-257-5111
Practice Address - Fax:802-254-0178
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274689207W00000X
VT042.0014963-COVID207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110138155AMedicaid