MEDICARE: THADDEUS D ENGLISH MPAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	103217	NC
2	363A00000X	Physician Assistant	103217	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00418893	OTHER	NC	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1376537969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THADDEUS D ENGLISH MPAC

Provider Business Mailing Address
First Line	:	206 HASTINGS LN
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3324
Country	:	US
Telephone Number	:	252-335-1083
Fax Number	:	252-335-4030

Provider Business Practice Location Address
First Line	:	206 HASTINGS LN
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3324
Country	:	US
Telephone Number	:	252-335-1083
Fax Number	:	252-335-4030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	12/11/2019

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Directions to “ THADDEUS D ENGLISH MPAC” Practice Location

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