Provider Demographics
NPI:1770585218
Name:TEREBUH, BORIS M (MD)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:M
Last Name:TEREBUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 PERIMETER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8052
Mailing Address - Country:US
Mailing Address - Phone:937-599-4443
Mailing Address - Fax:937-599-4403
Practice Address - Street 1:6860 PERIMETER DR
Practice Address - Street 2:SUITE A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8052
Practice Address - Country:US
Practice Address - Phone:937-599-4443
Practice Address - Fax:937-599-4403
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-067387T174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333997Medicaid
OS9326281Medicare ID - Type Unspecified
G60381Medicare UPIN