Provider Demographics
NPI:1144489766
Name:WALLACE, TERENCE J (MD)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:J
Last Name:WALLACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 READS WAY
Mailing Address - Street 2:STE. 201
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1630
Mailing Address - Country:US
Mailing Address - Phone:302-709-4709
Mailing Address - Fax:302-709-4551
Practice Address - Street 1:4755 OGLETOWN STANTON ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-1320
Practice Address - Country:US
Practice Address - Phone:302-733-1000
Practice Address - Fax:302-733-2685
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2016-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
DEC1-0010043207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE258507Y0JMedicare UPIN