Healthcare Provider Details

I. General information

NPI: 1154982619
Provider Name (Legal Business Name): OLIVIA TOEPFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 ELTON WAY STE 104
GREENSBORO NC
27406-8973
US

IV. Provider business mailing address

4002 ELTON WAY STE 104
GREENSBORO NC
27406-8973
US

V. Phone/Fax

Practice location:
  • Phone: 336-467-7501
  • Fax:
Mailing address:
  • Phone: 336-860-0981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: