Provider Demographics
NPI:1619972684
Name:EARLY, TODD F (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:F
Last Name:EARLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-7000
Mailing Address - Fax:
Practice Address - Street 1:2704 HENRY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3633
Practice Address - Country:US
Practice Address - Phone:336-621-3777
Practice Address - Fax:336-621-8374
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33994208600000X, 208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29822OtherBCBS
NC3700752OtherUHC
NC770001030OtherRR MCR
NC41439OtherMEDCOST
NC8929822Medicaid
NC8929822Medicaid
NC2160685Medicare PIN