Provider Demographics
NPI:1326852229
Name:TERRY, BRENSON
Entity type:Individual
Prefix:
First Name:BRENSON
Middle Name:
Last Name:TERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 LARGO RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8524
Mailing Address - Country:US
Mailing Address - Phone:240-646-2995
Mailing Address - Fax:
Practice Address - Street 1:2908 SPRIGGS REQUEST WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2582
Practice Address - Country:US
Practice Address - Phone:301-925-1515
Practice Address - Fax:301-925-1515
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant