Provider Demographics
NPI:1669489423
Name:PUGH, PHILLIP D (MA,MA,CERT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:D
Last Name:PUGH
Suffix:
Gender:M
Credentials:MA,MA,CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 MOORGATE AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-6037
Mailing Address - Country:US
Mailing Address - Phone:919-471-6418
Mailing Address - Fax:919-471-6418
Practice Address - Street 1:508 FULTON STREET
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-286-6805
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
Not Answered225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner