Provider Demographics
NPI:1497758411
Name:HARSTON, PHILLIP R (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:R
Last Name:HARSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-333-4104
Mailing Address - Fax:704-358-4544
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:STE 512
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2027
Practice Address - Country:US
Practice Address - Phone:704-333-4104
Practice Address - Fax:704-358-4544
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC26667207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology