Organization
DR JOSEPH R TERRACINA, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATSY SMITH RICHARD (INSURANCE)
(662) 335-1103
Entity
Organization
Contact information
Practice address
2525 HIGHWAY 1 S STE A, GREENVILLE, MS 38701-8354
(662) 335-1103
(662) 335-8746
Mailing address
2525 HIGHWAY 1 S STE A, GREENVILLE, MS 38701-8354
(662) 335-1103
(662) 335-8746
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
12546
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111878
—
MS
01
—
123945001
AR MEDICAID PROVIDER NUMB
AR
01
—
1981966
LOUISIANA MEDICAID
LA
01
—
96649
AR BCBS PROVIDER NUMBER
AR
Enumeration date
04/14/2008
Last updated
12/17/2009
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