Provider Demographics
NPI:1104171404
Name:TERRAPIN CARE CENTERS LLC
Entity type:Organization
Organization Name:TERRAPIN CARE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-220-1930
Mailing Address - Street 1:9685 BALTIMORE AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1323
Mailing Address - Country:US
Mailing Address - Phone:301-220-1930
Mailing Address - Fax:301-220-1906
Practice Address - Street 1:9685 BALTIMORE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1323
Practice Address - Country:US
Practice Address - Phone:301-220-1930
Practice Address - Fax:301-220-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6706270001OtherMEDICARE NSC