Provider Demographics
NPI:1386757102
Name:TERRELONGE, ANTONIO E (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:E
Last Name:TERRELONGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3410
Mailing Address - Country:US
Mailing Address - Phone:305-587-2414
Mailing Address - Fax:305-938-8054
Practice Address - Street 1:1901 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3410
Practice Address - Country:US
Practice Address - Phone:305-587-2414
Practice Address - Fax:305-938-8054
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI24181Medicare UPIN
FLU4136Medicare PIN