Provider Demographics
NPI:1255549010
Name:TERRY, MELVIN ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:ANTHONY
Last Name:TERRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 MAGELLAN DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2639
Mailing Address - Country:US
Mailing Address - Phone:510-339-6033
Mailing Address - Fax:302-336-6033
Practice Address - Street 1:TANG CTR
Practice Address - Street 2:2222 BANCROFT WAY
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-543-0697
Practice Address - Fax:510-643-5079
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist