Provider Demographics
NPI:1306602594
Name:PHILIPP C WIRTH MD PLLC
Entity type:Organization
Organization Name:PHILIPP C WIRTH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIPP
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-729-0767
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28388-0442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 AVIEMORE CT
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9846
Practice Address - Country:US
Practice Address - Phone:315-729-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty