Provider Demographics
NPI:1679742373
Name:ANK, TODD M (BOCPO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:ANK
Suffix:
Gender:M
Credentials:BOCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 S GLENBURNIE RD STE C
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2632
Mailing Address - Country:US
Mailing Address - Phone:252-638-8989
Mailing Address - Fax:252-638-5989
Practice Address - Street 1:1505 S GLENBURNIE RD STE C
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2632
Practice Address - Country:US
Practice Address - Phone:252-638-8989
Practice Address - Fax:252-638-5989
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC21078222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704555Medicaid
NC7704555Medicaid