Provider Demographics
NPI:1720071301
Name:MCCASKILL, TERRY (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:MCCASKILL
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 1:6512 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6170
Mailing Address - Country:US
Mailing Address - Phone:775-826-1285
Mailing Address - Fax:775-284-4093
Practice Address - Street 1:6512 S MCCARRAN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6170
Practice Address - Country:US
Practice Address - Phone:775-826-1285
Practice Address - Fax:775-284-4093
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016536Medicaid
NVC96325Medicare UPIN
NV002016536Medicaid