Provider Demographics
NPI:1891769568
Name:FELTUS-ATKINSON, CAROLYN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:FELTUS-ATKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 5TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4270
Mailing Address - Country:US
Mailing Address - Phone:321-821-4882
Mailing Address - Fax:321-821-4890
Practice Address - Street 1:325 5TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4273
Practice Address - Country:US
Practice Address - Phone:321-821-8449
Practice Address - Fax:321-821-4890
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061483100Medicaid
F05182Medicare UPIN
09585Medicare ID - Type Unspecified