Provider Demographics
NPI:1376537969
Name:ENGLISH, THADDEUS D (MPAC)
Entity Type:Individual
Prefix:
First Name:THADDEUS
Middle Name:D
Last Name:ENGLISH
Suffix:
Gender:M
Credentials:MPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HASTINGS LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3324
Mailing Address - Country:US
Mailing Address - Phone:252-335-1083
Mailing Address - Fax:252-335-4030
Practice Address - Street 1:206 HASTINGS LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3324
Practice Address - Country:US
Practice Address - Phone:252-335-1083
Practice Address - Fax:252-335-4030
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103217363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00418893OtherRAIL ROAD MEDICARE
NC2753077DMedicare PIN
NCP28958Medicare UPIN