Provider Demographics
NPI:1902892698
Name:HIGH, PHILIP D
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:D
Last Name:HIGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 MOUNT DE CHANTAL RD
Mailing Address - Street 2:STE 1
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6332
Mailing Address - Country:US
Mailing Address - Phone:304-243-5671
Mailing Address - Fax:304-243-0642
Practice Address - Street 1:1203 MOUNT DE CHANTAL RD
Practice Address - Street 2:STE 1
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6332
Practice Address - Country:US
Practice Address - Phone:304-243-5671
Practice Address - Fax:304-243-0642
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
WV20391223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2039OtherLICENSE NO
WV0138210000Medicaid
WV0138210000Medicaid