Terry M. Eccles, MD, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

037680 Issued in CT

Legal business name

TERRY M. ECCLES, MD, LLC

Practice address

72-LL West Stafford Road
Stafford Springs, CT 06076

Phone

(860) 684-5015

Fax

(860) 684-3749

NPI assigned

Jul 26, 2011

Last updated

Nov 17, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Terry M. Eccles, MD

Title

Owner/Physician

Phone

(860) 684-5015

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416182400000",
    "number": "1952689945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72-LL WEST STAFFORD ROAD",
            "city": "STAFFORD SPRINGS",
            "state": "CT",
            "postal_code": "06076",
            "telephone_number": "860-684-5015",
            "fax_number": "860-684-3749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72-LL WEST STAFFORD ROAD",
            "city": "STAFFORD SPRINGS",
            "state": "CT",
            "postal_code": "06076",
            "telephone_number": "860-684-5015",
            "fax_number": "860-684-3749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERRY M. ECCLES, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-26",
        "last_updated": "2014-11-17",
        "status": "A",
        "authorized_official_last_name": "ECCLES",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "860-684-5015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "005863",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "037680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stafford Family Services
• Stafford Public Schools
• Stafford Springs CT SNF LLC
• Desirae Tabor-Bannister
• Naufel Tajudeen, PHARMD
• Gabriel John Thayer, D.C.
• The Treehouse Center for Children and Families, LLC
• Time to Thrive Therapy Services, LLC
• Town of Stafford (Stafford Family Services)
• Town of Stafford - Stafford Family Services

• Pediatrics Physician in Stafford Springs, CT
• Providers in Stafford Springs, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.