Provider Demographics
NPI:1174644314
Name:MCPHAIL, ERNEST FREDERICK III (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:FREDERICK
Last Name:MCPHAIL
Suffix:III
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:
Mailing Address - Fax:
Practice Address - Street 1:7210 VILLAGE MEDICAL CIR STE 225
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8035
Practice Address - Country:US
Practice Address - Phone:336-893-3080
Practice Address - Fax:336-893-3089
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00447208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN779450000Medicaid
MN340000956Medicare PIN