Provider Demographics
NPI:1033217583
Name:PFAFF, CHARLES A JR (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:PFAFF
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 SOUND DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2860
Mailing Address - Country:US
Mailing Address - Phone:252-726-9423
Mailing Address - Fax:252-726-0373
Practice Address - Street 1:4220 SOUND DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2860
Practice Address - Country:US
Practice Address - Phone:252-726-9423
Practice Address - Fax:252-726-0373
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101473363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8960286Medicaid
NCS43183Medicare UPIN
NC2763301Medicare ID - Type Unspecified