Healthcare Provider Details

I. General information

NPI: 1902892698
Provider Name (Legal Business Name): DR. PHILIP D HIGH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 04/13/2006

III. Provider practice location address

1203 MOUNT DE CHANTAL RD STE 1
WHEELING WV
26003-6332
US

IV. Provider business mailing address

1203 MOUNT DE CHANTAL RD STE 1
WHEELING WV
26003-6332
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-5671
  • Fax: 304-243-0642
Mailing address:
  • Phone: 304-243-5671
  • Fax: 304-243-0642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2039
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: