Individual
PHILIP CLARK VANDONGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211 VIRGINIA RD, EDENTON, NC 27932-9668
(252) 482-8451
Mailing address
148 GOV EDEN HOUSE RD, MERRY HILL, NC 27957-9444
(304) 839-7790
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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