Provider Demographics
NPI:1962646067
Name:HORBAL, TERRY MYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MYRON
Last Name:HORBAL
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 1:69 PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5132
Mailing Address - Country:US
Mailing Address - Phone:203-913-9193
Mailing Address - Fax:
Practice Address - Street 1:555 BRIDGEPORT AVE FL 2
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4749
Practice Address - Country:US
Practice Address - Phone:203-913-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT033304207LA0401X, 207LP2900X
CT033304207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1234567789OtherNA