Provider Demographics
NPI:1164484044
Name:FELTZ, TODD ALAN (PA-C)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
Last Name:FELTZ
Suffix:
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 1:5107 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3989
Mailing Address - Country:US
Mailing Address - Phone:252-255-5321
Mailing Address - Fax:252-565-0534
Practice Address - Street 1:5107 N CROATAN HWY STE 101
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3989
Practice Address - Country:US
Practice Address - Phone:252-255-5321
Practice Address - Fax:252-565-0534
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS86628Medicare UPIN
NC2749385BMedicare PIN