Provider Demographics
NPI:1598182370
Name:CHRISTLE, TERENCE JEAN (MD)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:JEAN
Last Name:CHRISTLE
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:KYLEMORE CLINIC
Mailing Address - Street 2:TENNEY PARK
Mailing Address - City:KILKENNY
Mailing Address - State:KILKENNY
Mailing Address - Zip Code:00000
Mailing Address - Country:IE
Mailing Address - Phone:35356-775-0070
Mailing Address - Fax:35356-775-0071
Practice Address - Street 1:15 GARRISON RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3019
Practice Address - Country:US
Practice Address - Phone:508-540-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73585208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery