Provider Information for 1124178579
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Mr. PHILIP LEE D'AGOSTINO M.Ed
Sex: Male
NPI: 1124178579
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1124178579 | ||||||||
| Enumeration Date | 2007-01-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5522 STRATHMORE DR RALEIGH, NC 27613-8706 United States Phone: 919-341-8431 | Fax: | ||||||||
| Primary Practice Address | 5522 STRATHMORE DR RALEIGH, NC 27613-8706 United States Phone: 919-341-8431 | Fax: | ||||||||
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