Provider Demographics
NPI:1235130477
Name:PHIPPS, ERVIN L (MD)
Entity type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:L
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 NASHVILLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1823
Practice Address - Country:US
Practice Address - Phone:252-453-7769
Practice Address - Fax:252-459-6539
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4635513OtherAETNA ID
NCD4352OtherMEDCOST ID
NC1445798OtherUNITED HEALTHCARE ID
NC3368838OtherCIGNA ID
NC67447OtherBLUE CROSS BLUE SHIELD
NC1105239OtherFIRST HEALTH ID
NC89676447Medicaid
NC89676447Medicaid
NCF35706Medicare UPIN
NCP00246327Medicare PIN