Provider Demographics
NPI:1295047595
Name:TERRY, SHARON MAXINE
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MAXINE
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6200
Mailing Address - Country:US
Mailing Address - Phone:301-483-3103
Mailing Address - Fax:301-483-3105
Practice Address - Street 1:8635 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6200
Practice Address - Country:US
Practice Address - Phone:301-483-3103
Practice Address - Fax:301-483-3105
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4168607 00.Medicaid