Provider Demographics
NPI:1659357879
Name:FLANAGAN, PHELICIA A (MD)
Entity Type:Individual
Prefix:
First Name:PHELICIA
Middle Name:A
Last Name:FLANAGAN
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 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-571-1040
Mailing Address - Fax:919-781-0247
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-571-1040
Practice Address - Fax:919-781-0247
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00980207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140WCOtherBCBS PROVIDER NUMBER
NC5901787Medicaid
NCI46460Medicare UPIN
NC2048998Medicare PIN