Provider Demographics
NPI:1376070466
Name:PHILLIP, EUREKA LLOWANNA (MD)
Entity Type:Individual
Prefix:
First Name:EUREKA
Middle Name:LLOWANNA
Last Name:PHILLIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 RUIN CREEK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5920
Mailing Address - Country:US
Mailing Address - Phone:252-492-9565
Mailing Address - Fax:252-492-5373
Practice Address - Street 1:451 RUIN CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5920
Practice Address - Country:US
Practice Address - Phone:252-492-9565
Practice Address - Fax:252-492-5373
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-02848208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics