Provider Demographics
NPI:1174773923
Name:TERRY, ANDREA L (DO)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:TERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 896206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6206
Mailing Address - Country:US
Mailing Address - Phone:252-633-8024
Mailing Address - Fax:252-633-8994
Practice Address - Street 1:2000 NEUSE BLVD # C
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-633-8024
Practice Address - Fax:252-633-8994
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2010-00478208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC159CHOtherBCBS
NC5915221Medicaid
NC159CHOtherBCBS