Provider Demographics
NPI:1992099600
Name:PHILLIPS, MICHAEL ZACHARY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ZACHARY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CHENEY AVE
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-6343
Mailing Address - Country:US
Mailing Address - Phone:304-535-6343
Mailing Address - Fax:304-535-4110
Practice Address - Street 1:175 CHENEY AVE
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-6343
Practice Address - Country:US
Practice Address - Phone:304-535-6343
Practice Address - Fax:304-535-4110
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25377207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine