Individual
DR. JOSEPH R TERRACINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D. P.A.
Contact information
Practice address
2525 HIGHWAY 1 S, SUITE 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
MEDICAID PROVIDER NUMBER
AR
01
—
1981966
LOUISIANA MEDICAID NUMBER
MS
01
—
96649
AR BCBS PROVIDER NUMBER
AR
Enumeration date
04/03/2006
Last updated
12/17/2009
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