Provider Demographics
NPI:1306157854
Name:BIDNICK, TERRENCE ALAN (M D)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:ALAN
Last Name:BIDNICK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CODE 250 9
Mailing Address - Street 2:GODDARD SPACE FLIGHT CENTER
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20771-0001
Mailing Address - Country:US
Mailing Address - Phone:301-286-6666
Mailing Address - Fax:
Practice Address - Street 1:CODE 250 9
Practice Address - Street 2:GODDARD SPACE FLIGHT CENTER
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20771-0001
Practice Address - Country:US
Practice Address - Phone:301-286-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00362832083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine