Provider Demographics
NPI:1518774868
Name:KING, TERRIS KING ANDRE
Entity type:Individual
Prefix:DR
First Name:TERRIS KING
Middle Name:ANDRE
Last Name:KING
Suffix:
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 1:8929 GREENS LN
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4240
Mailing Address - Country:US
Mailing Address - Phone:443-847-2018
Mailing Address - Fax:
Practice Address - Street 1:8929 GREENS LN
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4240
Practice Address - Country:US
Practice Address - Phone:443-847-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker