Provider Demographics
NPI:1043202963
Name:DEHOFF, PHILIP WILLIAM (M D)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WILLIAM
Last Name:DEHOFF
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1718 E 4TH ST
Mailing Address - Street 2:SUITE 907
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3261
Mailing Address - Country:US
Mailing Address - Phone:704-372-4000
Mailing Address - Fax:704-334-4855
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:SUITE 907
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3261
Practice Address - Country:US
Practice Address - Phone:704-372-4000
Practice Address - Fax:704-334-4855
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27155207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928277Medicaid
NC8928277Medicaid
NC205852BMedicare PIN