Provider Demographics
NPI:1396791620
Name:WALKER, PHILLIP J (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:J
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1620 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5848
Mailing Address - Country:US
Mailing Address - Phone:704-332-0366
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:BLDG 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2027
Practice Address - Country:US
Practice Address - Phone:704-348-2992
Practice Address - Fax:704-334-3061
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC22070207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-85347Medicaid
SCE85347Medicaid
NC211246Medicare ID - Type UnspecifiedMEDICARE #
SCE85347Medicaid