Individual
PHILIP CLARK VANDONGEN
Active
Individual
PHILIP CLARK VANDONGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
19090
WV
207P00000X
Emergency Medicine Physician
2012-01986
NC
207R00000X
Internal Medicine Physician
19090
WV
207R00000X
Internal Medicine Physician
Primary
2012-01986
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080977000
—
WV
05
—
58-0474-4
—
VA
Enumeration date
07/12/2005
Last updated
06/03/2021
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