Provider Demographics
NPI:1235459223
Name:AUSTIN, PHILLIP ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANDREW
Last Name:AUSTIN
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 695
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-0695
Mailing Address - Country:US
Mailing Address - Phone:252-715-5315
Mailing Address - Fax:252-715-1991
Practice Address - Street 1:2522 S CROATAN HWY STE 1B
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8993
Practice Address - Country:US
Practice Address - Phone:252-715-5315
Practice Address - Fax:252-715-1991
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine