Healthcare Provider Details

I. General information

NPI: 1902910672
Provider Name (Legal Business Name): WESTELL CAREW PHELAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N ROAD ST ALBEMARLE HOSPITAL HWY 17N
ELIZABETH CITY NC
27909
US

IV. Provider business mailing address

PO BOX 12017
NEWPORT NEWS VA
23612-2017
US

V. Phone/Fax

Practice location:
  • Phone: 252-384-4615
  • Fax: 252-384-4684
Mailing address:
  • Phone: 757-867-6101
  • Fax: 757-867-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28074
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: