Individual
TERRY L KETCHERSID
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2232 WILBORN AVE, SOUTH BOSTON, VA 24592
(434) 517-3914
(434) 517-3912
Mailing address
PO BOX 1115, SOUTH BOSTON, VA 24592
(434) 517-3515
(434) 572-4549
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101054573
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188149
ANTHEM
VA
Enumeration date
07/31/2006
Last updated
07/08/2007
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