Provider Demographics
NPI:1184922411
Name:TERREN M. HIMELFARB, M.D., P.A.
Entity type:Organization
Organization Name:TERREN M. HIMELFARB, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIMELFARB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-433-0760
Mailing Address - Street 1:1900 E NORTHERN PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2113
Mailing Address - Country:US
Mailing Address - Phone:410-433-0760
Mailing Address - Fax:410-532-3503
Practice Address - Street 1:1900 E NORTHERN PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2113
Practice Address - Country:US
Practice Address - Phone:410-433-0760
Practice Address - Fax:410-532-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCR437OtherCAREFIRST
MD4258TMOtherCAREFIRST
MDGROUP # PENDINGOtherMEDICAL ASSISTANCE
GAGROUP PTAN PENDINGOtherRAILROAD MEDICARE
MD201042 (GROUP PTAN)OtherMEDICARE