Provider Demographics
NPI:1467412130
Name:SUTHERLAND-PHILLIPS, DENISE HELENA (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:HELENA
Last Name:SUTHERLAND-PHILLIPS
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 1:4040 BARRETT DR
Mailing Address - Street 2:STE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6643
Mailing Address - Country:US
Mailing Address - Phone:919-783-5300
Mailing Address - Fax:919-783-5007
Practice Address - Street 1:1405 WEST BLVD
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-9170
Practice Address - Country:US
Practice Address - Phone:919-783-5300
Practice Address - Fax:919-783-5007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-01418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141MXOtherBLUE CROSS BLUE SHIELD OF
NC7006031OtherAETNA
NC4937014OtherCIGNA HEALTHCARE
NC5901842Medicaid
NC79576OtherUNITED HEALTHCARE
NC79576OtherUNITED HEALTHCARE
NC2348179Medicare ID - Type UnspecifiedGROUP PRICING NUMBER