Basic Information
| Provider Information | |||||||||
| NPI: | 1962499103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DWYER | ||||||||
| FirstName: | TERRENCE | ||||||||
| MiddleName: | XAVIER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8926 WOODYARD RD | ||||||||
| Address2: | SUITE 701 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207354220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018561682 | ||||||||
| FaxNumber: | 3018568214 | ||||||||
| Practice Location | |||||||||
| Address1: | 8926 WOODYARD RD | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207354220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018561682 | ||||||||
| FaxNumber: | 3018568214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 09/27/2011 | ||||||||
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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 | 207RR0500X | D36294 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 95423901 | 01 | CAREFIRST OF MARYLAND | OTHER | 168431ZAKW | 01 | MEDICARE MARYLAND | OTHER | 0101245370 | 01 | VIRGINIA LICENSE | OTHER | 157146YZW | 01 | METRO MEDICARE | OTHER | 46950039 | 01 | CAREFIRST NCA | OTHER | D36294 | 01 | MARYLAND LICENSE | OTHER | P00887805 | 01 | RAILROAD MEDICARE INDIVIDUAL PTAN | OTHER |