Provider Demographics
NPI:1316147481
Name:KRYSINSKI, TERRANCE RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:RAYMOND
Last Name:KRYSINSKI
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 1:16000 PERRY HWY
Mailing Address - Street 2:SUITE TWO
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-7541
Mailing Address - Country:US
Mailing Address - Phone:724-935-4200
Mailing Address - Fax:724-935-4226
Practice Address - Street 1:16000 PERRY HWY
Practice Address - Street 2:SUITE TWO
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-7541
Practice Address - Country:US
Practice Address - Phone:724-935-4200
Practice Address - Fax:724-935-4226
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-068030-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037827Medicare PIN
PAH15586Medicare UPIN