Provider Demographics
NPI:1548268279
Name:TERRELL, FREDDIE L (MD)
Entity type:Individual
Prefix:DR
First Name:FREDDIE
Middle Name:L
Last Name:TERRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 MCCANN DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1157
Mailing Address - Country:US
Mailing Address - Phone:859-737-4411
Mailing Address - Fax:859-737-2123
Practice Address - Street 1:1114 MCCANN DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1157
Practice Address - Country:US
Practice Address - Phone:859-737-4411
Practice Address - Fax:859-737-2123
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29797208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64297971Medicaid
KYP400039007Medicare PIN
KY0169Medicare PIN
KY64297971Medicaid
KY0635601Medicare PIN
KY340018447Medicare PIN
KYF90909Medicare UPIN