Provider Demographics
NPI:1457574741
Name:TERRIS, DESPINA (MD)
Entity Type:Individual
Prefix:
First Name:DESPINA
Middle Name:
Last Name:TERRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HAMILTON AVENUE
Mailing Address - Street 2:ST. FRANCIS MEDICAL CENTER - RADIATION ONCOLOGY DEPT.
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-1915
Mailing Address - Country:US
Mailing Address - Phone:609-599-5179
Mailing Address - Fax:
Practice Address - Street 1:601 HAMILTON AVE
Practice Address - Street 2:ST. FRANCIS MEDICAL CENTER - RADIATION ONCOLOGY DEPT.
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1915
Practice Address - Country:US
Practice Address - Phone:609-599-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039786L2085R0001X
NJ25MA049491002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4651788OtherAETNA PPO
NJ7351402Medicaid
NJP4232377OtherOXFORD
NJ6460687OtherAETNA HMO
NJ100212510502OtherAMERICHOICE
PAE74883Medicare UPIN
NJ7351402Medicaid