Provider Demographics
NPI:1982635124
Name:TERIBURY, FREDERICK LEROY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LEROY
Last Name:TERIBURY
Suffix:JR
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 1:590 OLD BARTON RD
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:NY
Mailing Address - Zip Code:13734-2328
Mailing Address - Country:US
Mailing Address - Phone:607-321-3386
Mailing Address - Fax:570-882-7404
Practice Address - Street 1:114 DESMOND ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2084
Practice Address - Country:US
Practice Address - Phone:570-882-7401
Practice Address - Fax:570-882-7404
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine