Provider Demographics
NPI:1982613303
Name:TERRANOVA, JODY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:LYNN
Last Name:TERRANOVA
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:131 COVENTRY STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-714-3690
Mailing Address - Fax:860-714-8683
Practice Address - Street 1:131 COVENTRY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1548
Practice Address - Country:US
Practice Address - Phone:860-714-3690
Practice Address - Fax:860-714-8683
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT044324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics