Provider Demographics
NPI:1285691170
Name:ALBANEZE, PHILIP ANTON (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANTON
Last Name:ALBANEZE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2145 HENRY TECKLENBURG DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5894
Practice Address - Country:US
Practice Address - Phone:843-556-0036
Practice Address - Fax:843-556-3871
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD466974208600000X
IN01052812A208600000X
SC83831208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC83831OtherSC MEDICAL LICENSE