Provider Demographics
NPI:1760293724
Name:ROBERSON, TERRANCE SR
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:
Last Name:ROBERSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GALLATIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2105
Mailing Address - Country:US
Mailing Address - Phone:860-789-8603
Mailing Address - Fax:
Practice Address - Street 1:117 GALLATIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2105
Practice Address - Country:US
Practice Address - Phone:860-789-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other