Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD443642 | PA |
NPI | 1427225911 |
---|---|
Provider Name | Dr. Shibu Mathew Philips |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes-Barre, PA 18711-3446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 17/03/2018 |