Basic Information
| Provider Information | |||||||||
| NPI: | 1770578734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERZELLA | ||||||||
| FirstName: | MARYANN | ||||||||
| MiddleName: | JOSE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 VERDAE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296074021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642720388 | ||||||||
| FaxNumber: | 8642139237 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 BATESVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296814816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642720388 | ||||||||
| FaxNumber: | 8642139237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 02/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA08565000 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 35742 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.