Provider Demographics
NPI:1922001940
Name:TERENZI, THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:TERENZI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:STE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1719
Mailing Address - Country:US
Mailing Address - Phone:860-714-6581
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:STE 2112
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1719
Practice Address - Country:US
Practice Address - Phone:860-714-4749
Practice Address - Fax:860-714-8439
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041490207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001414903Medicaid
CT660000044Medicare ID - Type Unspecified
CT001414903Medicaid