Provider Demographics
NPI:1841275781
Name:GRAMLICH, TERRY L (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:GRAMLICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:7730 FIRST PL
Practice Address - Street 2:SUITE A
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-6719
Practice Address - Country:US
Practice Address - Phone:800-331-7546
Practice Address - Fax:440-703-2155
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-060998G207ZC0500X, 207ZP0101X
GA034354207ZC0500X, 207ZP0101X
TXL8705207ZC0500X, 207ZP0101X
FLME90450207ZC0500X, 207ZP0101X
PAMD421664207ZC0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E88384Medicare UPIN