Provider Demographics
NPI:1730101155
Name:PHILLIPS, CHARLES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8001 FRANKLIN FARMS DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5108
Mailing Address - Country:US
Mailing Address - Phone:804-521-5800
Mailing Address - Fax:804-545-4340
Practice Address - Street 1:7611 FOREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-288-4827
Practice Address - Fax:804-288-4494
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032041207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA276207OtherANTHEM/VA HEALTHKEEPERS
VA276304OtherANTHEM/VA HEALTHKEEPERS
VA56258OtherSOUTHERN HEALTH SERVICES
VA60011755OtherRAILROAD MEDICARE
VA1426390OtherCIGNA
VA276237OtherANTHEM/VA HEALTHKEEPERS
VA44227OtherSENTARA HEALTH/OPTIMA
VA276363OtherANTHEM/VA HEALTHKEEPERS
VA311984OtherMAMSI
VA730149OtherAETNA/US HEALTHCARE HMO
VA90182OtherANTHEM/VA HEALTHKEEPERS
VA276278OtherANTHEM/VA HEALTHKEEPERS
VA25-00311OtherUNITED HEALTHCARE
VA27413300OtherFEDERAL BLACK LUNG
VA6056636Medicaid
VA4063662OtherAETNA/US HEALTHCARE
VA103856OtherANTHEM/VA HEALTHKEEPERS
VA27413300OtherFEDERAL BLACK LUNG
VA311984OtherMAMSI