Provider Demographics
NPI:1982720793
Name:PAVEL TERREROS PC
Entity Type:Organization
Organization Name:PAVEL TERREROS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERREROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-434-4445
Mailing Address - Street 1:1447 W HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-4231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1447 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-4231
Practice Address - Country:US
Practice Address - Phone:610-434-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2430504001OtherINDEPENDENCE BLUE CROSS
PA50054589OtherCAPITAL BLUE CROSS
PA1763921OtherHIGHMARK BLUE SHIELD
PA7018763OtherAETNA
PA1553404OtherGATEWAY MEDICARE ASSURED
PA8404242001OtherCIGNA
PA094194Medicare ID - Type Unspecified
PA7018763OtherAETNA