Provider Demographics
NPI:1346288859
Name:ENSIGN, TODD D (PAC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:ENSIGN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 S CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-9709
Mailing Address - Country:US
Mailing Address - Phone:252-261-8040
Mailing Address - Fax:252-441-7041
Practice Address - Street 1:4923 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9709
Practice Address - Country:US
Practice Address - Phone:252-261-8040
Practice Address - Fax:252-441-7041
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant