Provider Demographics
NPI:1194710038
Name:PHILPOT, KELLY W (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:W
Last Name:PHILPOT
Suffix:
Gender:F
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 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 E FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4196
Practice Address - Country:US
Practice Address - Phone:252-744-1122
Practice Address - Fax:252-744-1133
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126FGMedicaid
NC126FGOtherBCBS NC
NC80162449OtherRAILROAD MEDICARE
NC126FGOtherBCBS NC
NC2280363Medicare PIN