Provider Demographics
NPI:1154391860
Name:FERTIG, NORMAN RICHARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:RICHARD
Last Name:FERTIG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SHAES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-6597
Mailing Address - Country:US
Mailing Address - Phone:910-270-9467
Mailing Address - Fax:
Practice Address - Street 1:PSC BOX 8023 BLDG. 4389
Practice Address - Street 2:
Practice Address - City:CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533-0023
Practice Address - Country:US
Practice Address - Phone:252-466-0255
Practice Address - Fax:252-466-0458
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant