Provider Demographics
NPI:1396704557
Name:TERRY, LUKE E JR (MD)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:E
Last Name:TERRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8700 CENTRAL AVE, STE 204
Mailing Address - Street 2:INTEGRATED MEDICAL CENTER, LLC
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785
Mailing Address - Country:US
Mailing Address - Phone:301-333-3770
Mailing Address - Fax:301-333-3779
Practice Address - Street 1:8700 CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4868
Practice Address - Country:US
Practice Address - Phone:301-333-3770
Practice Address - Fax:301-333-3779
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220581500Medicaid
MD220581500Medicaid
MDD74774Medicare UPIN