Individual
MR. MARK LUCAS PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
522 N ELAM AVE, STE 203, GREENSBORO, NC 27403-1151
(336) 852-8444
(336) 852-8401
Mailing address
522 N ELAM AVE, STE 203, GREENSBORO, NC 27403-1151
(336) 852-8444
(336) 852-8401
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
25639
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17619
PARTNERS
NC
01
—
2007829
UNITED HEALTHCARE
NC
01
—
371987800
USDOL
IL
01
—
5703760
VA MCD
VA
01
—
67625
BLUE CROSS BLUE SHIELD
NC
01
—
720000034
RR MEDICARE
NC
05
—
8967625
—
NC
01
—
99475
MEDCOST
NC
Enumeration date
01/04/2006
Last updated
03/30/2009
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