Provider Demographics
NPI:1295483469
Name:LOTT, TERRILL HENRY
Entity type:Individual
Prefix:
First Name:TERRILL
Middle Name:HENRY
Last Name:LOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-93 RTE. 23 POMPTON AVE.
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009
Mailing Address - Country:US
Mailing Address - Phone:201-815-0605
Mailing Address - Fax:
Practice Address - Street 1:91-93 RTE. 23 POMPTON AVE.
Practice Address - Street 2:SUITE 1001
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009
Practice Address - Country:US
Practice Address - Phone:201-815-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450770928202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology