Provider Demographics
NPI:1033259320
Name:EATON, PHILIP ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:EATON
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 1:203 MOCKSVILLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3359
Mailing Address - Country:US
Mailing Address - Phone:704-636-0971
Mailing Address - Fax:704-636-0769
Practice Address - Street 1:203 MOCKSVILLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3359
Practice Address - Country:US
Practice Address - Phone:704-636-0971
Practice Address - Fax:704-636-0769
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYIP859207N00000X
HI14758207N00000X
NC2008-00827207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911719Medicaid
NC2073904Medicare PIN