Provider Demographics
NPI:1316909724
Name:TERRACINA, JOSEPH R (MD PA)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:TERRACINA
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2525 HIGHWAY 1 S STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8354
Mailing Address - Country:US
Mailing Address - Phone:662-335-1103
Mailing Address - Fax:662-335-8746
Practice Address - Street 1:2525 HIGHWAY 1 S
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8354
Practice Address - Country:US
Practice Address - Phone:662-335-1103
Practice Address - Fax:662-335-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12546207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1981966OtherLOUISIANA MEDICAID NUMBER
MS0111878Medicaid
AR123945001OtherMEDICAID PROVIDER NUMBER
AR96649OtherAR BCBS PROVIDER NUMBER
AR123945001OtherMEDICAID PROVIDER NUMBER
MS1981966OtherLOUISIANA MEDICAID NUMBER