Provider Demographics
NPI:1649287996
Name:MCLAUGHLIN, TERRY GREY (PA-C)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:GREY
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 37 BOX 963
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:WV
Mailing Address - Zip Code:24938-9585
Mailing Address - Country:US
Mailing Address - Phone:304-591-7152
Mailing Address - Fax:
Practice Address - Street 1:HC 37 BOX 963
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:WV
Practice Address - Zip Code:24938-9585
Practice Address - Country:US
Practice Address - Phone:304-591-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV352363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMC6034501Medicare Oscar/Certification
WVQ70416Medicare UPIN