Basic Information
| Provider Information | |||||||||
| NPI: | 1457574741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERRIS | ||||||||
| FirstName: | DESPINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 HAMILTON AVENUE | ||||||||
| Address2: | ST. FRANCIS MEDICAL CENTER - RADIATION ONCOLOGY DEPT. | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086291915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095995179 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 HAMILTON AVE | ||||||||
| Address2: | ST. FRANCIS MEDICAL CENTER - RADIATION ONCOLOGY DEPT. | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086291915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095995179 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | MD039786L | PA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 25MA04949100 | NJ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 4651788 | 01 | NJ | AETNA PPO | OTHER | 7351402 | 05 | NJ | MEDICAID | P4232377 | 01 | NJ | OXFORD | OTHER | 6460687 | 01 | NJ | AETNA HMO | OTHER | 100212510502 | 01 | NJ | AMERICHOICE | OTHER |