Provider Demographics
NPI:1104905397
Name:TSCHIRLEY, TERRY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WAYNE
Last Name:TSCHIRLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 226
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-273-2730
Mailing Address - Fax:401-831-9025
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-273-2730
Practice Address - Fax:401-831-9025
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04951207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020212Medicaid
RI9020212Medicaid
RI069020212Medicare ID - Type Unspecified
RI069020212Medicare PIN