Provider Demographics
NPI:1962499103
Name:DWYER, TERRENCE XAVIER (MD)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:XAVIER
Last Name:DWYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8926 WOODYARD RD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4220
Mailing Address - Country:US
Mailing Address - Phone:301-856-1682
Mailing Address - Fax:301-856-8214
Practice Address - Street 1:8926 WOODYARD RD
Practice Address - Street 2:SUITE 602
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4220
Practice Address - Country:US
Practice Address - Phone:301-856-1682
Practice Address - Fax:301-856-8214
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD36294207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
95423901OtherCAREFIRST OF MARYLAND
168431ZAKWOtherMEDICARE MARYLAND
0101245370OtherVIRGINIA LICENSE
157146YZWOtherMETRO MEDICARE
46950039OtherCAREFIRST NCA
D36294OtherMARYLAND LICENSE
P00887805OtherRAILROAD MEDICARE INDIVIDUAL PTAN
D36294OtherMARYLAND LICENSE
0254450001Medicare NSC
46950039OtherCAREFIRST NCA