Provider Demographics
NPI:1861497265
Name:TERRY, ANDREW NICHOLAS JR (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:NICHOLAS
Last Name:TERRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A
Other - Middle Name:NICHOLAS
Other - Last Name:TERRY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:113 GAINSBOROUGH SQ
Mailing Address - Street 2:STE 300
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1714
Mailing Address - Country:US
Mailing Address - Phone:757-547-9286
Mailing Address - Fax:757-547-5692
Practice Address - Street 1:113 GAINSBOROUGH SQ
Practice Address - Street 2:STE 300
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1714
Practice Address - Country:US
Practice Address - Phone:757-547-9286
Practice Address - Fax:757-410-0186
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006076629Medicaid
B61959Medicare UPIN
VA006076629Medicaid