Provider Demographics
NPI:1720173420
Name:MARKS, PHILLIP GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:GLENN
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-8765
Mailing Address - Fax:910-362-9123
Practice Address - Street 1:1814 NEW HANOVER MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5350
Practice Address - Country:US
Practice Address - Phone:910-662-8765
Practice Address - Fax:910-362-9123
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39444208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2150804COtherPSC MEDICARE PROVIDER #
NC53944OtherBLUE CROSS/BLUE SHIELD-NC
NC8953944Medicaid
NCP00064804OtherRAILROAD MEDICARE
NC2150804AMedicare ID - Type Unspecified
NCP00064804OtherRAILROAD MEDICARE
NC53944OtherBLUE CROSS/BLUE SHIELD-NC