Provider Demographics
NPI:1316942741
Name:TERRILL, ROBERT Q (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:Q
Last Name:TERRILL
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 1:123 SUMMER ST
Mailing Address - Street 2:STE 685
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1200
Mailing Address - Country:US
Mailing Address - Phone:508-363-6446
Mailing Address - Fax:508-363-7117
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:STE 685
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1200
Practice Address - Country:US
Practice Address - Phone:508-363-6446
Practice Address - Fax:508-363-7117
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72507174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9730320Medicaid
J09484Medicare PIN
E38730Medicare UPIN