Provider Demographics
NPI:1639509185
Name:SCRUGGS, PHILLIP MICHAEL (RPA/RA)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:RPA/RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 BUFFALO MARSH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:VA
Mailing Address - Zip Code:22645-2053
Mailing Address - Country:US
Mailing Address - Phone:540-336-3422
Mailing Address - Fax:
Practice Address - Street 1:160 EXETER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-8614
Practice Address - Country:US
Practice Address - Phone:540-545-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0132000009243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant