Provider Demographics
NPI:1780876359
Name:TEREPKA, RAYMOND HARRIS (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HARRIS
Last Name:TEREPKA
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 1:509 CODDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6013
Mailing Address - Country:US
Mailing Address - Phone:607-277-0260
Mailing Address - Fax:
Practice Address - Street 1:509 CODDINGTON RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-6013
Practice Address - Country:US
Practice Address - Phone:607-277-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153278-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology