Provider Demographics
NPI:1881805331
Name:WARDINSKY, TERRANCE DAVID SR (MD)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:DAVID
Last Name:WARDINSKY
Suffix:SR
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 1:411 EDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3604
Mailing Address - Country:US
Mailing Address - Phone:707-446-6345
Mailing Address - Fax:916-489-1380
Practice Address - Street 1:2135 BUTANO DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0447
Practice Address - Country:US
Practice Address - Phone:916-978-6263
Practice Address - Fax:916-489-1380
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC043165208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79968Medicare UPIN