Basic Information
| Provider Information | |||||||||
| NPI: | 1417938267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRESSLER | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 S 2ND ST | ||||||||
| Address2: | SUITE 2F | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318472 | ||||||||
| FaxNumber: | 7172318490 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SOUTH SECOND STREET | ||||||||
| Address2: | SUITE 4B | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171012515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318472 | ||||||||
| FaxNumber: | 7172318490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | OS004932L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | OS004932L | 01 | PA | MEDICAL LICENSE | OTHER | 000966549 | 05 | PA | MEDICAID | 0009665490012 | 05 | PA | MEDICAID | 000783985 | 01 | PA | PA BLUESHIELD GROUP NO | OTHER |