Provider Demographics
NPI:1003828716
Name:IULIANO, PHILIP JAMES (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:IULIANO
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-526-3005
Mailing Address - Fax:336-526-3011
Practice Address - Street 1:189 SAMARITANS RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2472
Practice Address - Country:US
Practice Address - Phone:336-526-3005
Practice Address - Fax:336-526-3011
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046177L207RC0000X
NC34359207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945353Medicaid
NC45353OtherBCBS
NC1003828716Medicaid
P00206531OtherRAILROAD MEDICARE
SCN34359Medicaid
NCNC3578AMedicare PIN
NC8945353Medicaid
NC2168302EMedicare PIN
NC45353OtherBCBS
F19690Medicare UPIN
SCN34359Medicaid