Provider Demographics
NPI:1134393952
Name:DR JOSEPH R TERRACINA, MD, PA
Entity type:Organization
Organization Name:DR JOSEPH R TERRACINA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-335-1103
Mailing Address - Street 1:2525 HIGHWAY 1 S STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8354
Mailing Address - Country:US
Mailing Address - Phone:662-335-1103
Mailing Address - Fax:662-335-8746
Practice Address - Street 1:2525 HIGHWAY 1 S STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8354
Practice Address - Country:US
Practice Address - Phone:662-335-1103
Practice Address - Fax:662-335-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12546207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1981966OtherLOUISIANA MEDICAID
AR96649OtherAR BCBS PROVIDER NUMBER
MS0111878Medicaid
AR123945001OtherAR MEDICAID PROVIDER NUMB
MS512G700187Medicare PIN
MS0111878Medicaid