Provider Demographics
NPI:1043279730
Name:SCHUMPERT, TERENCE DURAN (MD)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:DURAN
Last Name:SCHUMPERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:42 MARKET ST
Mailing Address - Street 2:PO BOX 698
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1747
Mailing Address - Country:US
Mailing Address - Phone:315-126-5492
Mailing Address - Fax:315-268-1723
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:MASSENA MEMORIAL HOSPITAL
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1056
Practice Address - Country:US
Practice Address - Phone:315-265-4924
Practice Address - Fax:315-268-1723
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2017-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY220205-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH42576Medicare UPIN